Cephalic vein: Saviour in the microsurgical reconstruction of breast and head and neck cancers
A 56-year-old male patient was diagnosed with recurrent cancer of lower alveolus on the right side. The first surgery was done 4 years back during which the patient underwent segmental mandibulectomy and reconstructed with free vascularised fibula flap followed by post-operative radiotherapy. The patient was now planned for a wide local excision along with part of the previously reconstructed fibula [Figure and ] and reconstruction with free fibula from the other leg. The flap artery was anastomosed to the superior thyroid artery and the flap vein was anastomosed to the right IJV in an end-side fashion. The patient developed venous problem on post-operative day 3. On exploration, the anastomotic site was thrombosed []. Because of previous surgery and RT, the IJV was densely adhered to surrounding tissue and had thin wall, not suitable for a second anastomosis. The cephalic vein was transposed and the venous anastomosis was done [Figure and ] and the flap settled.