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Frequently a large branch establishes a communication between the systems of the great and small saphenous veins in the region of the popliteal space, or across the front of the upper part of the tibia. The superficial position of this last branch and its proximity to the bone render it liable to injury.
If the patient is placed on a couch and the limb elevated, the veins are emptied, and if pressure is then made over the region of the saphenous opening and the patient allowed to stand up, so long as the great saphena system alone is involved, the veins fill again very slowly from below.
Ligation of the saphenous vein at two points, one above and the other below the distended ligamentous capsule, is an old operation, which has undoubtedly given good results in some cases, although it does not seem to be a rational procedure. After-Care. After swelling has fully developed which occurs within a week the subject is turned to pasture and no attention is necessary thereafter.
#Lower Extremity.# The popliteal glands include one superficial gland at the termination of the small saphenous vein, and several deeper ones in relation to the popliteal vessels. They receive lymph from the toes and foot, and transmit it to the inguinal glands.
When interrogated as to the cause of his enormous saphenous veins, which stood out like huge twisted cords under the skin and were associated with venous varicosity on the leg, he said he presumed they were caused by his constantly compressing the saphenous vein at the hip in giving his exhibitions, which in some large cities were repeated several times a day. Endurance of Pain.
These pouches vary in size from a bean to a hen's egg, the larger forms being called venous cysts, and being most commonly met with in the region of the saphenous opening and of the opening in the popliteal fascia. [Illustration: FIG.
If the small saphena system also is involved, and if communicating branches are dilated, the veins fill up from below more rapidly. When the pressure over the saphenous opening is removed, the blood rapidly rushes into the varicose vessels from above; this is known as Trendelenburg's test. There are usually one or more bunches of enlarged and tortuous veins in the region of the knee.
The femoral glands lie vertically along the upper part of the great saphenous vein, and receive lymph from the leg and foot; from them the lymph passes to the deep inguinal and external iliac glands. The femoral glands often participate in pyogenic infections entering through the skin of the toes and sole of the foot. The lymph passes on to the deep inguinal and external iliac glands.
A new sheath may be provided for the tendon by resecting a portion of the great saphenous vein. Injuries of the tendons of the fingers are comparatively common. One of the best known is the partial or complete rupture of the aponeurosis of the extensor tendon close to its insertion into the terminal phalanx drop- or mallet-finger.
The affection is frequently bilateral, and may be associated with lymph scrotum, with elephantiasis, and with chyluria. The diagnosis is to be made from such other swellings in the groin as hernia, lipoma, or cystic pouching of the great saphenous vein. It is confirmed by finding the recently dead or dying worms in the inflamed lymph glands. Treatment.
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