Cephalic vein transposition in head and neck microsurgery: Advantages of a modified step-wise...
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9. Kopacz DJ, Emanuelsson BM, Thompson GE, et al. Pharmacokinetics of ropivacaine and bupivacaine for bilateral intercostals blockade in healthy male volunteers. Anesthesiology 1994;81:1139e48. 10. Hickey R, Blanchard J, Hoffman J, et al. Plasma concentrations of ropivacaine given with or without epinephrine for brachial plexus block. Can J Anaesth 1990;37:878e82. 11. Mulroy MF, Burgess FW, Emanuelsson BM. Ropivacaine 0.25% and bupivacaine 0.5%, but not 0.125% provide effective wound infil- tration analgesia after outpatient hernia repair, but with sus- tained plasma drug levels. Reg Anesth Pain Med 1999;24:136e41. 12. Horn EP, Schroeder F, Wilhelm S, et al. Wound infiltration and drain lavage with ropivacaine after major shoulder surgery. Anesth Analg 1999;89:1461e6. 13. Guinard JP, Carpenter RL, Owens BD, et al. Comparison between ropivacaine and bupivacaine after subcutaneous injection in pigs: cutaneous blood flow and surgical bleeding. Reg Anesth 1991;16:268e71. 14. Cederholm I, Evers H, Lo ¨fstro ¨m JB. Skin blood flow after intra- dermal injection of ropivacaine in various concentrations with and without epinephrine evaluated by laser Doppler flowme- try. Reg Anesth 1992;17:322e8. 15. Moffitt DL, De Berker DA, Kennedy CT, et al. Assessment of ropivacaine as a local anesthetic for skin infiltration in skin surgery. Dermatol Surg 2001;27:437e40. 16. Product information: http://www.lea.de/pdf/Lea/product/ 050614_Method_eng.pdf. SURGICAL TIP Cephalic vein transposition in head and neck microsurgery: Advantages of a modified step-wise (closed) technique The cephalic vein is occasionally used for venous drainage in complex head and neck reconstruction. The vein may be located through a linear incision but we propose an alternative, ‘step-wise’ technique. A semicircular incision is made similar to that used when raising a deltopectoral flap with an apex just below the level of the coracoid process. The cephalic vein is then identified in the deltopectoral groove and is approached in the arm through a series of small (2 cm) horizontal incisions directly over the vein, resulting in less risk of vessel damage and a speedier harvest. 1 The longitudinal approach, apart from predis- posing to potentially worse scarring requiring revision (such as via Z plastic correction), also precludes the subsequent use of the deltopectoral flap. The modified closed step-wise approach simultaneously imparts delay to any future deltopectoral flap, whilst keeping the option of the use of this flap open for future salvage procedures (Figure 1). Conflict of interest The authors have no conflicts of interest. Reference 1. Kim KA, Chandrasekhar BS. Cephalic vein in salvage microsur- gical reconstruction in the head and neck. Br J Plast Surg 1998 Jan;51:2e7. Tommaso Agostini Vittorugo Agostini Department of Plastic and Reconstructive Surgery, University of Florence, Largo Palagi 1, 50134 Florence, Italy E-mail address: [email protected] Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. doi:10.1016/j.bjps.2008.12.030 Figure 1 Donor site at four months. Cephalic vein transpo- sition using the modified step by step (closed) technique. A delayed deltopectoral flap can be a life-line in head and neck reconstruction and is not prejudiced. Ropivacaine 0.2% for TRAM flap reconstruction 625
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Transcript of Cephalic vein transposition in head and neck microsurgery: Advantages of a modified step-wise...
Ropivacaine 0.2% for TRAM flap reconstruction 625
9. KopaczDJ,EmanuelssonBM,ThompsonGE,etal.Pharmacokineticsof ropivacaine and bupivacaine for bilateral intercostals blockadein healthy male volunteers. Anesthesiology 1994;81:1139e48.
10. Hickey R, Blanchard J, Hoffman J, et al. Plasma concentrationsof ropivacaine given with or without epinephrine for brachialplexus block. Can J Anaesth 1990;37:878e82.
11. Mulroy MF, Burgess FW, Emanuelsson BM. Ropivacaine 0.25% andbupivacaine 0.5%, but not 0.125% provide effective wound infil-tration analgesia after outpatient hernia repair, but with sus-tainedplasmadrug levels.RegAnesthPainMed1999;24:136e41.
12. Horn EP, Schroeder F, Wilhelm S, et al. Wound infiltration anddrain lavage with ropivacaine after major shoulder surgery.Anesth Analg 1999;89:1461e6.
Figure 1 Donor site at four months. Cephalic vein transpo-sition using the modified step by step (closed) technique.A delayed deltopectoral flap can be a life-line in head andneck reconstruction and is not prejudiced.
13. Guinard JP, Carpenter RL, Owens BD, et al. Comparisonbetween ropivacaine and bupivacaine after subcutaneousinjection in pigs: cutaneous blood flow and surgical bleeding.Reg Anesth 1991;16:268e71.
14. Cederholm I, Evers H, Lofstrom JB. Skin blood flow after intra-dermal injection of ropivacaine in various concentrations withand without epinephrine evaluated by laser Doppler flowme-try. Reg Anesth 1992;17:322e8.
15. Moffitt DL, De Berker DA, Kennedy CT, et al. Assessment ofropivacaine as a local anesthetic for skin infiltration in skinsurgery. Dermatol Surg 2001;27:437e40.
16. Product information: http://www.lea.de/pdf/Lea/product/050614_Method_eng.pdf.
SURGICAL TIP
Cephalic vein transposition in head and neckmicrosurgery: Advantages of a modified step-wise(closed) technique
The cephalic vein is occasionally used for venousdrainage in complex head and neck reconstruction.
The vein may be located through a linear incision butwe propose an alternative, ‘step-wise’ technique. Asemicircular incision is made similar to that used whenraising a deltopectoral flap with an apex just below thelevel of the coracoid process. The cephalic vein is thenidentified in the deltopectoral groove and isapproached in the arm through a series of small(2 cm) horizontal incisions directly over the vein,resulting in less risk of vessel damage and a speedierharvest.1 The longitudinal approach, apart from predis-posing to potentially worse scarring requiring revision(such as via Z plastic correction), also precludes thesubsequent use of the deltopectoral flap. The modifiedclosed step-wise approach simultaneously imparts delayto any future deltopectoral flap, whilst keeping theoption of the use of this flap open for future salvageprocedures (Figure 1).
Conflict of interest
The authors have no conflicts of interest.
Reference
1. Kim KA, Chandrasekhar BS. Cephalic vein in salvage microsur-gical reconstruction in the head and neck. Br J Plast Surg1998 Jan;51:2e7.
Tommaso AgostiniVittorugo Agostini
Department of Plastic and Reconstructive Surgery,University of Florence, Largo Palagi 1, 50134 Florence,
ItalyE-mail address: [email protected]
Published by Elsevier Ltd on behalf of British Association ofPlastic, Reconstructive and Aesthetic Surgeons.
doi:10.1016/j.bjps.2008.12.030
