Free serratus anterior fascial flap combined with vascularized scapular bone for reconstruction of dorsal hand and finger defects

Kitazawa, Takeshi; Shiba, Masato; Tsunekawa, Kazuhiro

doi:10.1080/23320885.2017.1415760

Cited by 6 publications

(5 citation statements)

References 20 publications

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“…Although the serratus fascia flap provides good functional and aesthetic outcomes, the potential drawbacks include the high partial flap loss rate and the tedious, bloody dissection. Meticulous hemostasis is crucial during the elevation of the fascia from the underlying muscle [16]. The vascular pedicle runs along the superficial surface of the fascia and eventually branches over the muscle surface.…”

Section: Discussionmentioning

confidence: 99%

“…The lack of substantial muscle tissue in the free fascial flap makes it extremely prone to blood flow obstruction, such as venous thrombosis. For this reason, the use of an ultrasonic blade was propagated to avoid damage to the flap during elevation [16].…”

Section: Discussionmentioning

confidence: 99%

“…Although they represent the thinnest available flaps, reconstructive microsurgeons are reluctant to apply them generously. Drawbacks are possible donor-site morbidity with iatrogenic alopecia after temporoparietal fascia flap harvest on the one hand, and the variations of the serratus anterior blood supply, as well as the meticulous hemostasis during serratus fascia flap harvest, on the other hand [16,17]. Another drawback is the possible failure of split-thickness skin grafts [18].…”

Section: Introductionmentioning

confidence: 99%

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Reconstruction of Hand and Foot Defects with Free Serratus Carpaccio Flap and Free Serratus Fascia Flap: A Comparative Retrospective Study of Surgical Outcomes

Tee

Bigdeli

Thomas

et al. 2023

JCM

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Background: Defects of the hand and foot often require an individualized reconstructive approach, due to their unique functional and aesthetic characteristics. Transferred tissues should be thin, pliable, and durable, with free fascial flaps meeting these requirements. This study aimed to evaluate the serratus fascia flap and the serratus carpaccio flap, which is a modification of the fascia flap, by including a thin muscle layer, with the goal of enhancing flap resilience and lowering morbidity rates. Methods: Between January 2000 and December 2017, 31 patients underwent microsurgical reconstruction of the hand or foot either by serratus fascia flap (fascia group) or serratus carpaccio flap (carpaccio group). The serratus fascia flaps were mainly harvested between 2000 and 2012, and the serratus carpaccio flaps between 2013 and 2017. Patient records were reviewed retrospectively, regarding demographics, complications, overall flap survival, additional revision surgeries, and surgical outcome. Categorical variables were compared using Fisher’s exact test and continuous data with the Mann–Whitney tests. Logistic regression was used to examine the correlation between comorbidities and postoperative complication rates. Differences were considered significant when p < 0.05. Results: The fascia group consisted of 17 patients and the carpaccio group of 14 patients. The average patient age in the fascia group was 39.2 ± 10.5 years, and it was 39.1 ± 14.7 years in the carpaccio group. Overall complication rates were significantly lower in the carpaccio group than in the fascia group (28.6% vs. 70.6%, p = 0.03). The rates of overall flap survival (85.7% in the carpaccio group vs. 74.5% in the fascia group, p = 0.66) and partial flap loss (14.3% in the carpaccio group vs. 47.1% in the fascia group, p = 0.07) did not differ significantly among both groups. One postoperative hematoma of the donor site requiring revision surgery was reported in the carpaccio group (7.1%, p = 0.45) while no donor-site morbidity was reported in the fascia group. Conclusions: Our findings indicate that the serratus carpaccio flap presents a promising alternative to the serratus fascia flap. This modification has proven to be effective in substantially reducing postoperative complications requiring additional surgical interventions. Therefore, the serratus carpaccio flap can be considered a dependable reconstructive option for addressing complex soft tissue defects of the hand and foot, with complication rates that are within an acceptable range.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reconstruction of Hand and Foot Defects with Free Serratus Carpaccio Flap and Free Serratus Fascia Flap: A Comparative Retrospective Study of Surgical Outcomes

Tee

Bigdeli

Thomas

et al. 2023

JCM

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“…4 Kitazawa et al described another thoracodorsal-based composite flap using serratus anterior fascia and scapular bone for phalangeal defects. 5 Advantages cited for this specific flap were the small size match of scapular bone to phalangeal bone, fascia facilitating tendon gliding, and lack of donor site morbidity. Compared with this variation, the SR composite flap is more easily dissected and has muscle attached, facilitating postoperative monitoring.…”

Section: Discussionmentioning

confidence: 99%

Serratus Anterior-rib Composite Flap Partial Thumb Reconstruction

Qureshi

Tadisina

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Summary: The serratus anterior-rib composite flap is a well described and versatile flap used for reconstruction in a variety of anatomical regions. However, reconstruction of a thumb defect using this flap has not been well described since first mentioned in the literature by the Buncke et al group 20 years ago. The authors describe the use of this technique for thumb reconstruction in a complex defect from a gunshot wound.

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“…More recently, several authors have described single-stage reconstruction of dorsal hand defects with composite cutaneotendinous flaps, including the dorsalis pedis cutaneotendinous flap [18] and the composite anterolateral thigh flap taken with fascia lata [19][20][21] . Composite flaps including bone have also been described, such as the free serratus anterior fascial flap with vascularized scapula for combined soft tissue and bony defects of the dorsal hand [22] . The primary disadvantage of composite flaps, particularly the cutaneotendinous dorsalis pedis flap or anterolateral thigh fascia lata flap, is the chance of considerable donor site morbidity.…”

Section: Soft Tissue Coveragementioning

confidence: 99%

Microsurgical salvage of complex dorsal shearing injuries of the hand and wrist

Murthy¹

2020

Plast Aesthet Res

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Dorsal shearing injuries of the hand and wrist can be seen with high-energy motor vehicle accidents and present challenging problems to the reconstructive surgeon. At the time of initial injury, care must be taken to adequately debride the mangled extremity and extensive wounds. Following debridement, a series of decisions must be made regarding bony stabilization, extensor tendon reconstruction, and soft tissue coverage. These reconstructions often require staged procedures, and appropriate planning is warranted from the start. Reasonable function of the hand can be expected from the patient following such injuries.

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Free serratus anterior fascial flap combined with vascularized scapular bone for reconstruction of dorsal hand and finger defects

Cited by 6 publications

References 20 publications

Reconstruction of Hand and Foot Defects with Free Serratus Carpaccio Flap and Free Serratus Fascia Flap: A Comparative Retrospective Study of Surgical Outcomes

Reconstruction of Hand and Foot Defects with Free Serratus Carpaccio Flap and Free Serratus Fascia Flap: A Comparative Retrospective Study of Surgical Outcomes

Serratus Anterior-rib Composite Flap Partial Thumb Reconstruction

Microsurgical salvage of complex dorsal shearing injuries of the hand and wrist

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