branches run upwards and medially from it to join the great saphenous vein. The small saphenous vein is accompanied by the sural nerve — a sensory branch of the tibial nerve (Fig. 178a), which may be damaged in operating on varices of this vein.
The great (long) saphenous vein drains the medial part of the venous plexus on the dorsum of the foot and passes upwards immediately in front of the medial malleolus (Fig. 154); here branches of the saphenous nerve lie in front of and behind the vein. The vein then ascends over the posterior parts of the medial condyles of the tibia and femur to the groin where it pierces the deep fascia at the saphenous opening 1in (2.5 cm) below the inguinal ligament, to enter the femoral vein immediately medial to the femoral pulse.
The great saphenous vein is joined by one or more branches from the small saphenous, and by the lateral accessory vein which usually enters the main vein at the mid-thigh, although it may not do so until the saphenous opening is reached.
At the groin a number of tributaries from the lower abdominal wall, thigh and scrotum enter the great saphenous vein; these tributaries are variable in number and arrangement but usually comprise (Fig. 180):
1 the superficial epigastric vein;
2 the superficial circumflex iliac vein;
The superficial epigastric vein communicates with the lateral thoracic tributary of the axillary vein via the thoracoepigastric vein. This dilates (and may become readily visible coursing over the trunk), following obstruction of the inferior vena cava. The great saphenous vein communicates with the deep venous system not only at the groin but also at a number of points along its course through perforating veins; one is usually present a hand's breadth above, another a hand's breadth below the knee.
The skin of the medial aspect of the leg is drained to the deep veins by two or three direct perforating veins which pierce the deep fascia behind the great saphenous vein.
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