title: Head and neck reconstruction using cephalic vein transposition in the vessel-depleted neck.
abstract: In microvascular reconstructive surgery the patency of the recipient vessels is the key to successful outcome. In head and neck surgery there is often a lack of adequate recipient vessels as a result of chemoradiation therapy and ablative surgery. To overcome this it is crucial to identify vessels of adequate length and diameter outside the field of injury. We report our experience with cephalic vein transposition for drainage of seven free flaps--six intestinal and one osteocutaneous--for head and neck reconstruction. In five cases the cephalic vein was used during the free flap transfer and in two cases in salvage re-exploration surgery. All flaps survived completely. The anatomical course and location of the cephalic vein allow good patency and straightforward harvesting. Its vascular properties are predictive of reduced incidence of complications such as flap congestion and failure. We suggest that the cephalic vein offers a high venous flow drainage system for large free flaps and advocate its use in free intestinal transfer in the vessel-depleted neck as well as in re-exploration surgery.
authors.affiliation: Department of Surgery, St Bartholomew's and The Royal London Hospitals, Barts and The London NHS Trust, Whitechapel, London E11BB, United Kingdom.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Vasilakis
authors.forename: Hasu D L
authors.initials: HD
authors.lastname: Patel
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D002056:Burns / Q000601:surgery*; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D009333:Neck / Q000098:blood supply*; D010614:Pharynx / Q000293:injuries*; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation