Mayo's method is planned on similar lines; be divides the saphenous vein in the upper part of the thigh after ligaturing it; the distal end of the vein is then drawn through a steel ring mounted at an angle on a long handle, and by pushing downwards this contrivance the trunk of the vein is stripped of its branches, and at a distance of S inches from the first incision the ring is cut down upon, and this extent of vein pulled out through the wound. The ring enucleator is again introduced into the new' incision, and the operation repeated till the entire trunk is removed.
Recently an heroic operation has been introduced by Riendfleisch ; a piece of the internal saphenous haying been excised in the a spiral incision is commenced below the knee, passing round the leg several times till the foot is reached, cutting through all the varices more than once and down to the muscular fascia: veins which continue to bleed are and the wound plugged and made to heal by granulation.
A new method of sealing up the trunk and its tributary branches has been devised and carried out by Schiassi of Bologna. He divides the
saphenous vein high up after ligature, and into the open distal end of the dilated trunk he injects a weak solution of Iodine, after which he closes the vein by a ligature, shutting in about i oz. of the solution.
A new rapid excision operation has been introduced by Babcock and modified by Gray of Aberdeen, which gives excellent results. The vein is divided in the upper part of the thigh, and its proximal end is ligatured. Into the distal end a long metal stilet is passed as far as the ankle if possible. The olive-tipped extremity of this is cut down upon, and the entire vein is drawn through the lower wound, the upper portion of the vein having been previously fastened to the other end of the stilet.
The main objection to this method, as it is also the objection to Mayo's method, is that in removing the main vein the tributaries are torn across and bleed into the track of the main vessel. To obviate this, operation should be performed with the foot well elevated, and care taken to press out all blood from the affected channel before applying the bandage.