The deep veins of the lower extremity accompany the arteries. The femoral and popliteal veins are single, but the arteries below have venae comites. These deep veins all have valves and there are frequent communications with the superficial veins.

On the dorsum of the foot is a venous arch which unites with the inner dorsal digital vein to form the commencement of the internal or long saphenous vein. The outer extremity unites with the outer dorsal digital vein to form the commencement of the external or short saphenous vein.

The internal or long saphenous vein begins just in front of the internal malleolus, ascends on the inner surface of the tibia, passes along the posterior border of the internal condyle and thence up to the saphenous opening. In the leg it communicates with the deep anterior and posterior tibial and external saphenous veins and in the thigh with the femoral. At or near the saphenous opening it receives the external superficial femoral vein from the outer anterior surface of the thigh and the internal superficial femoral vein from the inner posterior portion of the thigh. Not infrequently one of these lateral branches may be almost as large as the internal saphenous itself and may be mistaken for it. From the knee down the internal saphenous vein is accompanied by the internal saphenous nerve.

The external or short saphenous vein begins behind the external malleolus, ascends alongside the tendo calcaneus (Achillis), thence over the gastrocnemius to empty into the popliteal vein. Its branches anastomose with those of the internal saphenous on the inner side of the leg and it communicates through the deep fascia with the deep veins. It is accompanied by the external saphenous nerve.

Varicose Veins Of The Leg

A varicose condition of the veins of the leg is very common. Often the cause cannot be ascertained, but not infrequently pelvic tumors, and especially pregnancy, produce the condition by obstructing the blood-current. The veins become distended and the valves, of which there are many, become insufficient. This destroys the valvular support of the blood column and the veins become tortuous and inflamed, the walls thicken and may become adherent to the skin. The walls in places give way, causing hemorrhages. They may become thin and sacculated and thrombi may form and suppurate. The treatment consists in ligat-ing and excising as many of the affected veins as possible. The internal saphenous is especially to be excised, beginning a short distance below the saphenous opening and extending for the greater portion of its length (Fig. 563).

Fig. 563.   Varicose veins, affecting especially the internal or long saphenous vein.

Fig. 563. - Varicose veins, affecting especially the internal or long saphenous vein.

The operation of Max Schede, of circular incision around the leg just below the knee, dividing everything down to the deep fascia, is usually effective, but we have seen recurrences even after it, due to regurgitation from the deep veins. In fat people the internal saphenous may lie imbedded in the superficial fat some distance beneath the skin.

A varicose condition of the veins of the leg is a causative factor in chronic leg ulcer; hence, in order to cure it, the necessity of elevating the limb in its treatment, or excising the veins.

Lymphatics Of The Leg

Sometimes there are one or two lymphatic nodes at the upper extremity of the anterior tibial artery but usually the first to be encountered are around the popliteal vessels, - below that point are only lymphatic radicles or vessels.