Locating veins is imperative for precise flap design and prediction of flap survival. However, detection of subcutaneous veins is often difficult in the trunk and proximal extremities, especially in obese, highly pigmented, and elderly patients. Several devices have been used clinically, including an audible Doppler probe, ultrasonography, and the indocyanine green near-infrared camera. Although the audible Doppler device is simple and easy to use, only audio information is available. Although ultrasonography can locate and visualize the vasculature, it is difficult to perform in all patients because of the cost, time, and accessibility. In addition, direct contact with the patient’s skin with application of fungible material is necessary.
Recently, vein visualization devices, including the AccuVein AV300 (AccuVein, Inc., Huntington, N.Y.), have been introduced clinically as tools that facilitate identification of veins for venipuncture.1,2 The AV300 is a handheld, noninvavsive device that displays the position of subcutaneous veins on the patient’s skin and enables identification of veins that evaded detection not only by the naked eye, but also ultrasound because of its relatively shallow location (Fig. 1). This device operates by illuminating the skin with near-infrared light of 785-nm wavelength; because hemoglobin absorbs infrared light of this wavelength, skin regions with a lower level of reflection indicate vein locations. This device then captures the reflected light, processes it, and projects it back onto the skin using red light. As a result, the location of veins is shown in black lines. We introduced this device in plastic and reconstructive surgery. To the best of our knowledge, the application of this device in reconstructive surgery has not been described.
Since 2011, we have applied a vein visualization device (AccuVein AV300) to locate subcutaneous veins in 12 cases. The detected veins included the great saphenous vein, cephalic vein, superficial inferior epigastric vein, and superficial circumflex iliac vein, for the purpose of flap harvesting, vein grafting, and detection of recipient vessels in free flap transfer and lymphaticovenous anastomosis. The veins were found correctly in the marked area in all cases (Fig. 2). (See Video, Supplemental Digital Content 1, which shows subcutaneous veins visualized and marked using the near-infrared vein visualization device, http://links.lww.com/PRS/A552.)
This device enables us to locate and map subcutaneous veins, that otherwise might be undetectable, easily and quickly in real-time. Other advantages of this device include portability, the absence of direct contact with patients (thus sterilization is not necessary), and the ease with which it can be learned and used. No calibration or adjustments are necessary. This device can provide useful preoperative information, and we believe that this device will assist plastic surgeons, especially in flap surgery, in combination with other devices.
The authors have no financial interest in any of the products or devices mentioned in this article.
Takuya Iida, M.D.
Makoto Mihara, M.D.
Hidehiko Yoshimatsu, M.D.
Hisako Hara, M.D.
Mitsunaga Narushima, M.D.
Isao Koshima, M.D.
Department of Plastic and Reconstructive Surgery
University of Tokyo
1. Perry AM, Caviness AC, Hsu DC. Efficacy of a near-infrared light device in pediatric intravenous cannulation: A randomized controlled trial. Pediatr Emerg Care. 2011;27:5–10
2. Chapman LL, Sullivan B, Pacheco AL, Draleau CP, Becker BM. VeinViewer-assisted intravenous catheter placement in a pediatric emergency department. Acad Emerg Med.. 2011;18:966–971
Supplemental Digital Content
©2012American Society of Plastic Surgeons