Anatomy of the saphenous nerve: relevance to saphenous vein stripping.

Sensory impairment in the saphenous nerve distribution after stripping of the long saphenous vein was studied in 14 patients undergoing bilateral vein stripping for symptomatic varicose veins. The vein was stripped upward in one leg and downward in the other to determine whether the direction in which the vein is stripped contributes to the incidence of such sensory impairment. Sensory evaluations at 12 weeks postoperatively revealed that ten of the 14 legs in the group that had the veins stripped upward demonstrated significant objective sensory deficits (P less than 0.001) compared with those that had the veins stripped downward (zero of 14). At 6 months the results were similar. To obtain anatomic correlation with the clinical findings, ten fresh cadaver dissections were carried out. In four of five legs in which the vein was stripped in an upward direction, the pretibial branch was avulsed off the main trunk and in two of five, the infrapatellar branch was avulsed. Such nerve avulsions did not occur on downward stripping. We recommend that the long saphenous vein be stripped downward to avoid sensory impairment in the saphenous nerve distribution.