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Utilization of the Cephalic Vein for Venous Drainage in Autologous Breast Reconstruction
Norcini, Rebecca; Henderson, Joshua T.; Brooke, Sebastian M.; Maalouf, Majed; Uygur, H. Safak
West Virginia University
2024-02-01
Presenter: Rebecca Norcini
Affidavit:
certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Kerri Woodberry
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction:
When the superficial inferior epigastric vein (SIEV) is utilized for venous outflow in deep inferior epigastric perforator (DIEP) flap breast reconstruction, it is important to select an easily accessible and reliable recipient vein. The cephalic vein is an underreported recipient vein and can be considered a primary target for drainage of the superficial system.
Methods:
A retrospective review was performed to identify patients who underwent dissection and transposition of the cephalic vein for anastomosis to the superficial system during autologous breast reconstruction. Surgical technique and outcomes were evaluated. A review of the literature was also performed to assess utilization of this vein for flap drainage.
Results:
Three patients who received DIEP flap reconstruction underwent harvest and transposition of the cephalic vein for connection to the SIEV. Two patients required SIEV-cephalic vein anastomoses for salvage of congested flaps. The third patient's DIEP flap exhibited superficial dominance prior to flap elevation, and the cephalic vein was chosen for recipient anastomosis during primary flap inset. All patients achieved viable flap reconstructions.
Literature review yielded 11 studies (six retrospective reviews and five case series) reporting utilization of cephalic vein supercharging in free flap breast reconstruction. These reports primarily present cephalic vein anastomosis as a salvage technique for venous thrombosis or congestion.
Conclusion:
The cephalic vein offers a large caliber outflow with a long leash and can be accessed through the breast pocket or through a small deltopectoral incision. It may be utilized in flap salvage or primarily during flap inset for anastomosis to the SIEV.
