Position the patient supine with the leg draped free and allow the leg to fall into external rotation to facilitate access to the greater saphenous vein and underlying structures. Plan symmetric fishmouth skin flaps anteriorly and posteriorly. The flaps should be of approximately the same size and length. Gently curve the fishmouth to avoid interfering with the blood supply to the tip of the flap.

Make a skin incision and deepen the incision down to the fascia overlying the muscle groups. Identify and ligate the greater saphenous vein in the medial portion of the anterior flap. Incise the fascia sharply.

The greater saphenous vein and a variable number of tributaries are the only structures of consequence in the superficial fascia of the thigh. The course of the greater saphenous vein can be approximated by a line running from a point 8 to 10 cm posterior to the medial side of the patella to a second point that is level with, and 4 cm lateral to, the pubic tubercle. Note that, in the thigh, the larger veins of this system are in a plane between two layers of superficial fascia. Frequently, a large communicating branch between the lesser and greater saphenous veins ascends obliquely around the medial side of the thigh; other large tributaries join the greater saphenous vein on its anterolateral side. One fairly common variant of the greater saphenous system that would necessitate additional vein ligations is duplication of the greater saphenous vein in the more distal part of the thigh. When such duplication occurs, one of the vessels is typically deeper than the other, although both are still within the superficial fascia.

The deep fascia of the thigh, or fascia lata, is not of equal thickness throughout. It is thicker proximally and especially laterally, where it is reinforced by the iliotibial tract, which is actually the long, flat tendon of insertion (to the lateral condyle of the tibia) of the tensor fascia lata and most of the gluteus maximus. In addition, the fascia lata is thickened distally about the knee joint, where it is reinforced by fibrous expansions from the biceps femoris muscle laterally, the sartorius muscle medially, and the quadriceps femoris muscle anteriorly.