Microvascular Free Transfer of Serratus Anterior and Rib Composite Flap



Microvascular Free Transfer of Serratus Anterior and Rib Composite Flap


W. C. LINEWEAVER

F. ZHANG

A. KELLS





The serratus anterior-rib composite flap is a versatile flap with use in reconstruction of both bone and soft-tissue defects. Clinical applications have shown that the serratus anterior-rib composite flap offers a long thoracodorsal vascular pedicle, large pedicle vessels for anastomoses, relatively simple dissection, soft-tissue coverage without large muscle bulk, and a favorable donor site.




ANATOMY

The serratus anterior muscle is located on the lateral thoracic wall. Its fibers arise from the outer surfaces of the upper 9 to 10 ribs anterolaterally and insert into the medial border of the scapula. The serratus anterior muscle receives a dual blood supply. The lateral thoracic artery, located anterior to the subscapular-thoracodorsal artery, enters the lateral surface of the muscle and then courses anteriorly with multiple branches into the muscle. The second blood supply is via the thoracodorsal artery, which has branches to the serratus anterior. Studies of dissections of the thoracodorsal artery showed that in 99% of cases, the thoracodorsal artery gave off one or more branches to the serratus anterior muscle (11). Rarely, this serratus pedicle can branch off directly from the axillary vessels (12).

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Jun 26, 2016 | Posted by in General Surgery | Comments Off on Microvascular Free Transfer of Serratus Anterior and Rib Composite Flap
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