The cephalic vein in microsurgery

Hallock, Geoffrey G.

doi:10.1002/micr.1920140804

Cited by 33 publications

(15 citation statements)

References 23 publications

(3 reference statements)

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“…8 The cephalic vein runs a superficial course that can be identified and designed preoperatively by using a proximal tourniquet. 10 Anatomically, the cephalic vein ascends in the groove between the brachioradialis and the brachii muscles. It reaches the antecubital fossa, where it communicates with the basilic vein via a large median cubital vein, as well as with the deep system via perforators.…”

Section: Discussionmentioning

confidence: 99%

“…8 The vessel's large caliber enhances size matching for tissue anastomosis. 3,8,10 Venous outflow through large diameter vessels is directly associated with higher free flap success 4 making the cephalic vein a superb candidate for fibular, anterolateral thigh, and intestinal free flaps. The length of the cephalic vein permits a long pedicle to be obtained, sufficient for high-level and contralateral anastomoses to take place under low tension.…”

Section: Discussionmentioning

confidence: 99%

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Head and neck reconstruction using cephalic vein transposition in the vessel‐depleted neck

2009

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Head and neck reconstruction using cephalic vein transposition in the vessel‐depleted neck

2009

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“…The cephalic vein originates from the radial end of the dorsal venous network of the hand (1,2), which is a formation of the convergence of dorsal metacarpal veins (3,4). The cephalic vein crosses superficial to the anatomical snuffbox at the base of the thumb and the surface of the radial styloid and runs along the lateral border of the limb.…”

Section: Introductionmentioning

confidence: 99%

Variation in the Course and Termination of the Cephalic Vein in the Deltopectoral Triangle

Dogood¹,

Aidemise²

2017

Acta Facultatis Medicae Naissensis

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The knowledge of cephalic vein variation would aid proper identification and prevent error in surgical emergencies. The path, distribution, and termination of the cephalic vein in relation to the deltopectoral triangle were studied in twenty formalin-embalmed cadavers.Results show the bilateral presentation of the cephalic vein in all the shoulders examined. Thirtyseven (37) cases presented with a superficial and lateral course of the cephalic vein in the deltopectoral groove, while the rest three cases presented a deep course. Of these 37 cases with the superficial course, two cases ascended anteriorly and above the clavicle and drained into the external jugular vein in the neck. Another case presented a cephalic vein that ascended anteriorly and then above the clavicle and drained into an unnamed vein in the neck. In one case, the cephalic vein ascended superficially in the deltopectoral groove and laterally in the deltopectoral triangle. In one bilateral pattern, the cephalic vein in the deltopectoral triangle drained into the axillary vein. In all the three cases where the cephalic vein ascended deep within the deltopectoral groove, they terminated deep in the deltopectoral triangle. In one of these, the cephalic vein received a tributary that originated from a venous network beneath the deltoid muscle and then drained into athe xillary vein, deep in the deltopectoral triangle. In the other two cases, the cephalic vein gave a tributary to the axillary vein and continued deep and medially in the deltopectoral triangle, passed below the clavicle and drained into the subclavian vein.The knowledge of these variations of the cephalic vein is essential to clinicians and surgeons for venous access during emergencies and surgery.

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“…Vein grafts or arteriovenous fistulas might then be needed, but these require multiple microanastomoses with inherent risks.5 Another possibility that has proven acceptable, at least on the venous side, is to form a vein loop using a large subcutaneous vein from an uninjured region for outflow from the free flap. 6 In unusual circumstances where direct access to a major upper extremity vessel or large branch is imprudent, then a reasonable corollary might be to form a forearm arterial loop in a similar fashion for flap inflow. Such a maneuver would eliminate vein grafts, require a single microanastomosis, and minimize vessel size discrepancies for the pedicle of most common free flaps.…”

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confidence: 99%

Forearm arterial loop as an expedient source for inflow to upper extremity free flaps

Hallock

1995

Microsurgery

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Challenging wounds of the upper extremity requiring free tissue transfers are relatively infrequent. As a direct consequence, methods to access recipient vessels or acceptable alternatives may not be as familiar as in the lower extremity. In rare circumstances, creation of an arterial loop by elevation of a portion of either major forearm artery provides an easily accessible, pristine source of inflow for a planned free flap matching vessels of comparable caliber. Such a maneuver may also be important to ensure preservation of optimal hand function by avoiding any dissection in the vicinity of essential musculotendinous and neurovascular structures that might reside within or adjacent to the zone of injury.

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The cephalic vein in microsurgery

Cited by 33 publications

References 23 publications

Head and neck reconstruction using cephalic vein transposition in the vessel‐depleted neck

Head and neck reconstruction using cephalic vein transposition in the vessel‐depleted neck

Variation in the Course and Termination of the Cephalic Vein in the Deltopectoral Triangle

Forearm arterial loop as an expedient source for inflow to upper extremity free flaps

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