Small saphenous vein ligation and segmental resection

The small saphenous vein rises in the subcutaneous tissue of the posterior side of the calf, enters the deep fascia under the transverse stripes of the armpit, and continues to ascend, entering the iliac vein at 2 to 3 cm above the transverse stripes of the armpit. A transverse incision of about 5 cm in length was made 2 to 3 cm above the armpit transverse stripes. After cutting the deep fascia, ligature and cut into the branches of the small saphenous vein to find the confluence of the small saphenous vein into the axillary vein. There is a radial nerve on the outside of the iliac vein and a radial artery on the inside. Avoid damage. After the small saphenous vein was isolated, high ligation and cutting were performed at the proximal end. The telecentric end is segmented and extracted in the same way as the saphenous vein. Treatment of diseases: varicose veins of the lower extremities Indication 1. The lower extremity superficial varicose veins are obvious, accompanied by calf pain and swelling, pigmentation, and chronic recurrent ulcer. 2. Small saphenous vein and traffic valvular insufficiency. 3. There is no history of deep vein thrombosis, and deep venous valve function is good. Contraindications 1. Old and frail, with diseases of heart, lung, liver, kidney and other important organs, poor surgical tolerance. 2. Those with deep veins are obstructed. 3. Combined with acute phlebitis or generalized suppurative infection. Preoperative preparation 1. There are ulcers in the lower limbs. After treatment, the wounds are clean and the inflammation is controlled. 2. Due to the wide range of surgery and trauma, antibiotics were applied 24 hours before surgery. 3. Shave the pubic hair and prepare the skin of the affected limb. 4. Mark the varicose veins and walking with gentian violet to facilitate surgery. Surgical procedure The small saphenous vein rises in the subcutaneous tissue of the posterior side of the calf, enters the deep fascia under the transverse stripes of the armpit, and continues to ascend, entering the iliac vein at 2 to 3 cm above the transverse stripes of the armpit. A transverse incision of about 5 cm in length was made 2 to 3 cm above the armpit transverse stripes. After cutting the deep fascia, ligature and cut into the branches of the small saphenous vein to find the confluence of the small saphenous vein into the axillary vein. There is a radial nerve on the outside of the iliac vein and a radial artery on the inside. Avoid damage. After the small saphenous vein was isolated, high ligation and cutting were performed at the proximal end. The telecentric end is segmented and extracted in the same way as the saphenous vein. complication 1. The anatomy of the small saphenous vein root should be clear, all branch veins must be cut and ligated to prevent recurrence. 2. If the local anesthesia is unclear or obese, the incision can be made in the medial or inferior calf incision, and the small saphenous vein can be separated. After the cutting, the stripper is inserted into the proximal end and pushed up to the groin. The small saphenous vein trunk can be found. 3. At the confluence of the small saphenous vein and the femoral vein, there is a layer of fascia between the two, which cannot be easily cut open to avoid accidental injury to the femoral vein. Once the femoral vein is damaged during operation, the incision should be immediately enlarged to fully expose the injured part of the femoral vein. The venous repair is performed with a 5-0 nylon thread. If the femoral vein is completely cut, an autologous small saphenous vein should be taken for interstitial vein grafting. 4. If the varicose veins are obviously distorted and cannot be inserted into the stripper smoothly, it is not necessary to retract one time. A small incision can be made, and the varicose veins are separated and ligated in the subcutaneous section. Then the remaining small saphenous vein is extracted. 5. If there is pigmentation, eczema or ulcer on the internal hemorrhoids, it indicates that the valve function of the medial malleolus is incomplete, and the small saphenous vein should be removed at the internal malleolus and the traffic branch should be ligated.

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