Cephalic vein in salvage microsurgical reconstruction in the head and neck

Free tissue transfers have significantly improved the outcome of major head and neck reconstruction. In some situations of microvascular tissue transfer, adequate recipient veins are not available for flap venous outflow. This may result from a variety of reasons, including prior radical neck dissection, radiation therapy, and inflammatory changes from severe trauma. We report our experience using cephalic vein transposition in 11 such patients with unavailable local veins for free flap reconstruction. In all cases the cephalic vein provided reliable and adequate outflow for the tissue transfers. Our experience suggests that the cephalic vein transposition offers certain advantages, obviating the use of vein grafts: 1. It requires only one venous anastomosis; 2. A long pedicle can be harvested to reach the mid-face or contralateral neck without undue tension; 3. The cephalic-subclavian system is a high-flow, low-pressure system; 4. This vein is located outside ablative surgical field, or radiated tissue, and therefore undamaged; 5. The vein calibre is well suited for microsurgical anastomosis.