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Stripping of the greater saphenous trunk and its varicose tributaries is indicated in symptomatic patients who have valvular incompetence, incompetent communicating veins, or resulting complications. The lesser saphenous system is unilaterally or bilaterally involved in 20 percent of these patients and, if affected, should also be stripped. Otherwise, this frequently causes recurrence. Before consideration of stripping, these patients must have a complete peripheral vascular examination to determine whether the varicosities are primary or secondary, to evaluate the status of the deep venous system, and to ascertain the adequacy of arterial circulation. Stigmata, history, suspicion, or other evidence of deep venous involvement suggesting that the varicosities may be secondary mandates the performance of impedance venous plethysmography or venography for objective evidence.
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Incompetence or obstruction of the deep venous system to such an extent that the superficial venous system is necessary for return flow contraindicates complete saphenous system stripping. However, in selected cases in which the varicosities are a major contributor to disabling complications, stripping up to knee level may be safe after careful assessment and critical judgment by the surgeon.
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Stasis dermatitis, cutaneous infections, or varicose ulcers result in a high incidence of postoperative wound infections. Pregnancy, advanced age, and systemic diseases constituting significant operative risks are relative contraindications, except in unusual circumstances.
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Healing of varicose ulcers and elimination of stasis eczema can almost always be achieved by use of local treatment, compression dressings, and elevation when at rest. If such lesions are healed at least 4 weeks before operation, the incidence of postoperative infections will be minimized and wound healing will be normal.
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The patient is instructed to take two cleansing hexachlorophene showers within 12 hours before operation. After the groin and extremity have been shaved, the involved saphenous trunks, major varicose tributaries, and location of suspected incompetent communicating veins—which can be detected by walking with a tourniquet applied at various levels or, better, yet with a Doppler—are then marked with indelible skin dye (Bonnie's blue or brilliant cresyl green). It is imperative that the ...