J Reconstr Microsurg 2009; 25(5): 319-321
DOI: 10.1055/s-0029-1215524
© Thieme Medical Publishers

A Reliable and Aesthetic Technique for Cephalic Vein Harvest in DIEP Flap Surgery

Thorir Audolfsson1 , Warren M. Rozen2 , Marcus J.D Wagstaff3 , Iain S. Whitaker4 , Rafael Acosta1
  • 1Department of Plastic Surgery, Uppsala Clinic Hospital, Uppsala, Sweden
  • 2Department of Anatomy and Cell Biology, The University of Melbourne, Victoria, Australia
  • 3Department of Plastic Surgery, University Hospitals of Sheffield, Sheffield, United Kingdom
  • 4Department of Plastic, Reconstructive and Burns Surgery, The Welsh National Plastic Surgery Unit, The Morriston Hospital, Swansea, United Kingdom
Further Information

Publication History

Publication Date:
27 April 2009 (online)

ABSTRACT

The need for a secondary source of venous drainage in deep inferior epigastric artery perforator flaps is common, with the cephalic vein commonly utilized as an alternative venous recipient vessel. In using the cephalic vein, previous studies have described the deltopectoral groove or the infraclavicular fossa as the site for harvest. We describe the use of an anterior axillary skin crease, which can improve aesthetic outcome, reduce the time needed for harvest, enable a greater length of vein to be transposed, and minimize surgical insult to the upper breast/chest wall. An anterior axillary-line skin fold can be used as the site for cephalic vein harvest, and using the methodology described, the technique can be fast and highly reliable and result in a final scar that is barely visible.

REFERENCES

  • 1 Blondeel P N. One hundred free DIEP flap breast reconstructions: a personal experience.  Br J Plast Surg. 1999;  52 104-111
  • 2 Blondeel P N, Arnstein M, Verstraete K et al.. Venous congestion and blood flow in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps.  Plast Reconstr Surg. 2000;  106 1295-1299
  • 3 Wechselberger G, Schoeller T, Bauer T, Ninkovic M, Otto A, Ninkovic M. Venous superdrainage in deep inferior epigastric perforator flap breast reconstruction.  Plast Reconstr Surg. 2001;  108 162-166
  • 4 Marck K W, van der Biezen J J, Dol J A. Internal mammary artery and vein supercharge in TRAM flap breast reconstruction.  Microsurgery. 1996;  17 371-374
  • 5 Tutor E G, Auba C, Benito A, Rábago G, Kreutler W. Easy venous superdrainage in DIEP flap breast reconstruction through the intercostal branch.  J Reconstr Microsurg. 2002;  18 595-598
  • 6 Niranjan N S, Khandwala A R, Mackenzie D M. Venous augmentation of the free TRAM flap.  Br J Plast Surg. 2001;  54 335-337
  • 7 Villafane O, Gahankari D, Webster M. Superficial inferior epigastric vein (SIEV): “lifeboat” for DIEP/TRAM flaps.  Br J Plast Surg. 1999;  52 599
  • 8 Lundberg J, Mark H. Avoidance of complications after the use of deep inferior epigastric perforator flaps for reconstruction of the breast.  Scand J Plast Reconstr Surg Hand Surg. 2006;  40 79-81
  • 9 Guzzetti T, Thione A. The basilic vein: an alternative drainage of DIEP flap in severe venous congestion.  Microsurgery. 2008;  28 555-558
  • 10 Mehrara B J, Santoro T, Smith A et al.. Alternative venous outflow vessels in microvascular breast reconstruction.  Plast Reconstr Surg. 2003;  112 448-455
  • 11 Casey Jr W, Rebecca A M, Smith A A, Craft R O, Buchel E W. The cephalic and external jugular veins: important alternative recipient vessels in left-sided microvascular breast reconstruction.  Microsurgery. 2007;  27 465-469
  • 12 Barnett G R, Carlisle I R, Gianoutsos M P. The cephalic vein: an aid in free TRAM flap breast reconstruction. Report of 12 cases.  Plast Reconstr Surg. 1996;  97 71-76

Dr. Rafael Acosta

Chief of Reconstructive Microsurgery, Department of Plastic Surgery

Uppsala Clinic Hospital, Uppsala, 75185, Sweden

Email: rafael.acosta.rojas@akademiska.se

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