Free serratus anterior muscle transplantation for hand reconstruction

Logan, Samuel E.; Alpert, Bernard S.; Buncke, Harry J.

doi:10.1016/0007-1226(88)90174-9

Cited by 34 publications

(25 citation statements)

References 6 publications

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“…Existing FFMTs do not match thenar muscle morphology well, necessitating extensive intra-flap dissection (as with gracilis) or have unacceptable donor morbidity (as with extensor digitorium brevis [6,12,16]). They may also be a poor match for thenar muscle force dynamics (as with serratus anterior [4]). The nature of the small group of wounds that could indicate FFMT over traditional forms of reconstruction (tendon transfer, etc.)…”

Section: Discussionmentioning

confidence: 99%

Functional anconeus free flap for thenar reconstruction: a cadaveric study

Lee

Mitchell

et al. 2012

HAND

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Background Restoration of thumb opposition when significant thenar soft tissue defects occur remains a considerable surgical challenge. While several clinical applications of the anconeus muscle have been developed, free functioning muscle transfer (FFMT) of the anconeus for thenar reconstruction has not been reported previously. This study therefore sought to describe anatomical features of the anconeus that would determine its suitability for use as a FFMT. Methods The anconeus, its corresponding abductor pollicis brevis (APB), and the supplying neurovasculature in eight white British cadaveric upper extremities were identified and dissected. Measurements were performed using standard calipers and ImageJ 1.45d for a quantitative description of muscle architecture and the neurovasculature involved in the operative planning of the anconeus FFMT. Results The mean measures of the anconeus were larger than those of the APB (anconeus/APB fiber length088.0±9.9/57.7± 9.0 mm, area01,341.9±230.4/987.7±251.2 mm 2 ). There was no significant difference between mean fiber angles (anconeus/ APB070.5±11.9°/78.4±12.2°; p>0.05) and neurovasculature (anconeus/APB: artery diameter01.9±0.2/2.0±0.5 mm, nerve diameter01.7±0.3/2.1±0.4 mm; p>0.05). The length (31.3± 6.9 mm) and caliber (diameter01.9±0.2 mm) of the vascular pedicle of the anconeus (recurrent posterior interosseous artery) and its venae comitans (diameter01.0 mm) are sufficient for microsurgical anastomosis. Conclusions The anatomic rationale of the anconeus FFMT for thenar reconstruction is sound and, compared to other FFMTs, may provide several advantages: reliable and matching anatomy, minimal donor site morbidity, and the potential to restore a greater degree of opposition and thus function in a one-stage procedure.

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Section: Discussionmentioning

confidence: 99%

Functional anconeus free flap for thenar reconstruction: a cadaveric study

Lee

Mitchell

et al. 2012

HAND

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“…19 Another donor site complication was represented by the possibility of both weakness or decrease of shoulder motion and winged scapula, which can be prevented or minimized by harvesting only the lowest two or three slips of the SA muscle. 21,[40][41][42] If also other slips are to be harvested, these complications can be prevented by anchoring the remaining posterior portions of the used slips to the periosteum of the superjacent and subjacent ribs.…”

Section: Discussionmentioning

confidence: 99%

Long‐term results after muscle‐rib flap transfer for reconstruction of composite limb defects

et al. 2011

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The authors present the long-term results in a series of 44 cases with post-traumatic bone defects solved with muscle-rib flaps, between March 1997 and December 2007. In these cases, we performed 21 serratus anterior-rib flaps (SA-R), 10 latissimus dorsi-rib flaps (LD-R), and 13 LD-SA-R. The flaps were used in upper limb in 18 cases and in lower limb in 26 cases. With an overall immediate success rate of 95.4% (42 of 44 cases) and a primary bone union rate of 97.7% (43 of 44 cases), and despite the few partisans of this method, we consider that this procedure still remains very usefully for small and medium bone defects accompanied by large soft tissue defects.

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“…When pedicled flaps are not available, a free flap can be performed. Most free flaps can be used for a palmar defect, but the best results in this indication are obtained with the free serratus anterior muscle flap which provides a greater stability of the teguments of the hand and a lower donor site morbidity [6,7,16]. The free scapular and parascapular flaps are rather more used for palmar defects of the wrist, when a simple skin covering is not sufficient [4,12].…”

Section: Discussionmentioning

confidence: 99%