Technique

Passing vein grafts and the vascular pedicles of free flaps through a subcutaneous tunnel can be a time consuming process and may damage the vessels. For several years, the senior author of this article has used a rapid and relatively atraumatic technique to achieve this, modifying a previously published method (₁).

To transfer a vessel, the tip of a Yankauer sucker is gently pushed through the subcutaneous tissues, between the two sites of interest. The sucker is left in place creating a tunnel. Rarely, the Yankauer cannot be passed through easily and sharp dissection is required. Once the Yankaeur is in the correct position, the vein graft/pedicle is placed carefully into the open end of the sucker (Figure 1).

Figure 1

Figure 1: Interpolation of the left cephalic vein to supercharge a venously congested DIEP flap.

Gentle suction is then applied to the blunt end of the sucker.. The negative pressure pulls the vessels into the lumen of the Yankaeur, which is then gently withdrawn, pulling the vessels through the subcutaneous tunnel with it. Any twist in the vessels is (coincidentally) unravelled at the same time.

We routinely use this technique to tunnel vein grafts and the vascular pedicles of free flaps and believe it is a safe, rapid and simple method.

Correspondence to

E. Wilson, Department of Plastic Surgery, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UY Tel: 01603286286 Email: ewanwilson@doctors.org.uk