A 2-cm transverse incision, placed one fingerbreadth below and just anterior to the tip of the medial malleolus, and downward retraction will expose the trifurcated origin of the saphenous vein (Figure 5). Each of the three primary tributaries is divided and ligated. The saphenous vein is then dissected proximally above the malleolus for 4 cm. Sizable anterior and posterior tributaries are usually exposed, divided, and ligated (Figure 6). The edges of the transected lower end of the saphenous trunk are grasped between two mosquito hemostats and slit 1 cm to enhance the insertion of the probe end of the stripper (Figure 7). The instrument is then passed gently proximally with guidance by palpating, advancing fingers. The stripper can usually be passed through the entire length of the vein but may be arrested by large varices, tributaries, communicating veins, or by stenosis resulting from previous phlebitis. At these points an additional small transverse incision may be made to expose the vein and the tip of the stripper. The tip may then be manually guided proximally, or the vein may be transected to allow introduction of an additional stripper through the proximal end. Alternatively, a second stripper may be inserted into the proximal end of the divided saphenous trunk through the femoral incision and passed distally till it contacts the instrument inserted from the ankle. The end of the saphenous trunk is then securely tied to the stripper with two encircling ligatures of 00 silk, about 2 cm apart, to prevent inversion of the vein over the stripper (Figure 8).