Use of Cephalic Vein for Venous Anastomosis in Head and Neck Reconstruction

A Case Series

Mohammad Fazlur Rahman, MBBS, FCPS; Muhammad Asif Ahsan, MBBS, MRCPS, FCPS; Safdar Ali Shaikh, MBBS, FCPS; Muhammad Ubaid Khan, MBBS, FCPS; Sami ullah, MBBS, FCPS


ePlasty. 2020;20(e9) 

In This Article

Abstract and Introduction


Purpose: To describe the use of the cephalic vein as a recipient vessel for venous outflow in head and neck reconstruction. The cephalic vein is used as a vessel in cases where there is a paucity of veins in the neck. This may be due to previous surgery, previous radiation therapy, or advanced cancer. The cephalic vein may also be used to salvage a failing free flap.

Methods: It is a retrospective review of 230 free flaps that had been used in head and neck reconstruction performed from July 2014 to July 2018 by a single surgeon.

Results: There were 6 patients in whom the cephalic vein was used as a recipient vessel. The cephalic vein was used in 2 cases where a tumor was involved with the internal jugular vein, in 1 case where a previous neck dissection had been done, in 1 case where internal jugular vein had iatrogenic damage, and in 2 cases a salvage procedure was done. In all cases, the cephalic vein was rotated above the clavicle. The cephalic vein easily reached the free flap vein and had a good caliber. There were no failures in any of the patients.

Conclusion: The cephalic vein is a good option for venous anastomoses in patients in whom there is a paucity of recipient vessels in the neck.


Microvascular free flaps have become increasingly essential for patients requiring head and neck reconstruction, with success rates greater than 95%.[1] As success rates have increased, surgeons have started operating on more complex cases. Complexities include previous surgeries, previous radiotherapy, more advanced cancer, or a combination of these modalities.[2] Radiotherapy leads to intimal fibrosis and arteriosclerosis of the vessels. Previous surgery and extensive disease may lead to compromised vessel. Reconstructing free flaps in such cases is always a challenge as there is vessel depletion/unsuitability, particularly of veins. Commonly used veins that include ipsilateral external jugular vein (EJV) and internal jugular vein (IJV) are usually unavailable, thrombosed, or unsuitable for anastomosis.[3] In such cases, the surgeon is forced to look for other options. These include contralateral neck veins, use of a vein graft, or an alternate recipient vein.[4]

A good option for alternate recipient vein is the cephalic vein. Use of the cephalic vein in microsurgery was first described by Hallock.[5] Horng and Chen[6] called it the lifeboat for head and neck reconstruction. The first series was published by Kim and Chandrasekhar.[7] Here, we report our experience with using the cephalic vein as a recipient vein in cases of head and neck cancer reconstruction.