Great saphenous vein high ligation and stripping

1. The lower extremity superficial varicose veins are obvious, accompanied by calf pain and swelling, pigmentation, and chronic recurrent ulcer. 2. Large saphenous vein and traffic valvular insufficiency. 3. There is no history of deep vein thrombosis, and deep venous valve function is good. Treatment of diseases: saphenous veins Indication 1. The lower extremity superficial varicose veins are obvious, accompanied by calf pain and swelling, pigmentation, and chronic recurrent ulcer. 2. Large 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 1. Incision: In the medial femoral artery, a longitudinal or oblique incision is made from the inguinal ligament to the medial side. It is about 6cm long. 2. Separation of the great saphenous vein: the skin is removed, the subcutaneous tissue is cut, and the superficial fascia is cut inside the femoral artery to reveal the fossa ovalis, and the confluence of the saphenous vein and the femoral vein can be found. The large saphenous vein trunk was separated by a curved hemostat. 3. Cut off the saphenous vein branch: Separate along the venous stem, and find branches such as shallow circumflex, shallow abdominal wall, shallow genital area, ventrolateral side and medial femoral vein, and ligation and cutting one by one. The location and number of these branches vary greatly, so the department should be exposed as much as possible during surgery, and each branch should be carefully searched until the saphenous vein enters the femoral vein. 4. Ligation of the great saphenous vein: a thick silk thread is caused from the back of the great saphenous vein, and the great saphenous vein is ligated at a distance of 0.5 to 1.0 cm from the femoral vein. Clamp two hemostats at the distal end of the ligature, cut the vein between the jaws, and sew at the proximal end of the proximal clamp. 5. Insertion and advancement of the great saphenous vein stripper: Insert the hard or soft vein stripper down from the distal end of the severed vein and push it down the vein. If you encounter resistance, it may indicate that the venous tortuous part or the plane that has reached the deep vein communication branch. After the skin touches the membrane to the cylindrical metal head of the stripper, make another small incision in the corresponding skin to reveal the place. In the vein, the blood vessels are ligated at the upper and lower ends of the stripper head, and the vein is cut between the two ligatures. 6. Withdrawal of the vein: The stripper is pulled out evenly from the incision of the fossa ovalis, and the hemorrhage is stopped by the extraction, and the entire saphenous vein can follow. The saphenous vein can also be pulled out of the lower incision in the same manner. 7. Continue the segmental resection: continue to extract the varicose veins down from the lower incision in the same way until the ankle. After the main vein of the varicose vein is exfoliated, the large branches that still appear should be carefully separated and exfoliated. 8. Resection of the valve insufficiency of the valve: during the process of stripping the trunk or branching, if there is resistance and see the skin concealed, it is often suggested that there is a thick traffic branch, and another small incision should be made to the blood vessel. After separation, it is ligated and cut. 9. Stitching: suture each incision, and the entire lower limb is evenly wrapped with elastic bandages or elastic stockings to prevent bleeding in the exfoliation site.