Reversed cephalic vein: a lifeboat in head and neck free-flap reconstruction

Free flaps always followed surgical resection in head and neck cancer patients as a means of reconstruction. Problems may be encountered in recurrent patients who have received postoperative cervical irradiation, since finding a good, healthy vein for microanastomosis is sometimes difficult. The internal jugular vein, with or without vein grafting, as the recipient vessel may solve the problem. However, we encountered two patients in whom the internal jugular vein was very fibrotic as a result of irradiation. A long vein graft to the nonirradiated, healthy area was the only choice in this condition. A new method in which a reversed cephalic vein is used as the recipient vessel was designed. It seems that the reversed cephalic vein can play the role of lifeboat as recipient vein and solve the most difficult problem encountered in head and neck free-flap surgery.