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Ann Chir Plast Esthet. 2018 Feb;63(1):75-80. doi: 10.1016/j.anplas.2017.10.007. Epub 2017 Nov 16.

[Transposition of the cephalic vein in free flap breast reconstruction: Technical note].

[Article in French]

Author information

1
Service de chirurgie plastique, reconstructrice et esthétique, hôpital Européen-Georges-Pompidou, université Paris-Descartes, Assistance publique-hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France. Electronic address: thomas.silhol@aphp.fr.
2
Service de chirurgie plastique, reconstructrice et esthétique, hôpital Européen-Georges-Pompidou, université Paris-Descartes, Assistance publique-hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France. Electronic address: tabrez.suffee@gmail.com.
3
Service de chirurgie plastique, reconstructrice et esthétique, hôpital Européen-Georges-Pompidou, université Paris-Descartes, Assistance publique-hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France. Electronic address: mikael.hivelin@gmail.com.
4
Service de chirurgie plastique, reconstructrice et esthétique, hôpital Européen-Georges-Pompidou, université Paris-Descartes, Assistance publique-hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France. Electronic address: laurentlantieri@gmail.com.

Abstract

Free flaps have become a reliable practice for breast reconstruction. However, the venous congestion is still the most frequent reason of flap failure. It is due to bad quality of the internal mammary veins, a preferential superficial venous outflow of the flap or due to venous thrombosis. The transposition of the cephalic vein could useful in some cases. We describe the surgical technique and suggest an intraoperative algorithm. Seventeen patients (15 DIEP and 2 PAP) were included. Twenty nine point four percent had an unusable internal mammary vein, 23.5% a preferential superficial venous outflow and 47.1% a venous thrombosis. The length of the cephalic vein dissected varied from 15 to 25cm. The mean time of dissection was 39min. There was no flap failure after cephalic vein transposition. The sequelae were one or two scars on the arm without any functional morbidity. The transposition of the cephalic vein is a reliable, less morbid alternative in case of bad quality internal mammary vein with a good quality internal mammary artery, in case of an additional venous outflow necessity or in case of venous thrombosis.

KEYWORDS:

Breast reconstruction; Cephalic vein; DIEP; Free flap; Lambeau libre; PAP; Reconstruction mammaire; Veine céphalique

PMID:
29153868
DOI:
10.1016/j.anplas.2017.10.007
[Indexed for MEDLINE]

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