Editing Venous exposures (section)

== '''GSV''' ==

* Arises from the medial aspect of the dorsal pedal venous arch and ascends anterior to the medial malleolus, crossing the tibia at the junction of the distal middle third of the calf to pass posteromedial to femoral condyle at the knee. The vein then ascends medially in the thigh, remaining parallel to the medial edge of the sartorius muscle. It then perforates the deep fascia and joins CFV approximately 4cm below the inguinal ligament. 
* Saphenous nerve lies anterior to GSV in the calf
* Vein harvest:
** Start in the groin with an oblique incision, guided by pre-op USS
** Subcutaneous tissue divided with diathermy
** Anterior aspect of vein dissected with Metz. Dissect distally by initially undermining a pocket of skin over the vein, then sharply dividing skin and subcutaneous tissue onto an instrument held over the vein
** Vessel loop is applied for gentle counter-traction to allow further sharp dissection
** Ligate branches with silk ties on the proximal end and a small or medium weck clip on the distal branch
** Divide distally
** Use hep saline on an olive needle to distend the vein and identify untied branches