The operative technique of ligation and stripping of the short saphenous vein

The operative technique of ligation and stripping of the short saphenous vein

The short saphenous vein in a few patients may be the only one that needs to be removed. More frequently, however, both long and short saphenous veins are in­competent and should be stripped, although only about 15 per cent of all operative cases require this.

                  • After completion of the operative procedure on the long saphenous vein and the incompetent communicating veins and closure of the incisions, the patient is turned prone on the operating table with the feet projecting beyond it. The anes­thetic should be administered through an endotracheal tube to provide good aera­tion of the lungs and to prevent stridor with an increase in venous pressure that may lead to bleeding and subsequent hematomas. The operating table should be placed in moderate Trendelenburg position to reduce venous pressure in the legs, thereby also preventing bleeding from the unligated branches of the stripped short saphenous vein.
                  • This shows the extent of the operative field that gives the most adequate ex­posure of the distribution of the short saphenous vein. It facilitates a much more adequate removal of the vein than attempting to do the procedure with all the ac­robatics necessary when the patient is in the supine position. The vein is first ex­posed posterior to the external malleolus through a short transverse incision as shown on the left leg.
                  • With good retraction and sharp scissor dissection the trunk of the short saphenous vein (1) is readily exposed. The sural nerve (2) lies parallel and often adherent to it. It is important to isolate this nerve to prevent interrupting it when dividing the vein trunk, even though it is entirely a sensory nerve. This is because the nerve supplies the skin of the outer side of the foot, and it would become anesthetic, which would be troublesome to the patient, especially when wearing a shoe.
                  • This shows the distal end of the short saphenous trunk after division and beginning insertion of the small end of the stripper into it. In a few instances when the distal end of the vein is large, it may be stripped down to its termination on the anterolateral side of the foot.

The operative technique of ligation and stripping of the short saphenous vein


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