Reconstruction of Soft-Tissue Defects Using Serratus Anterior Adipofascial Free Flap

Abstract

The serratus anterior muscle has been suggested as a versatile and reliable flap for reconstruction of head and neck and extremity injuries. The adipofascial layer overlying the serratus anterior muscle is the anatomic layer, which is supplied by the same branch of thoracodorsal artery. Even though great progress has occurred in the prevention of postoperative adhesion of extremity injuries, the problem has not been completely solved and is still of special importance in complex injuries. Between March of 1995 and February of 1996, seven patients underwent reconstructive operation as a result of soft-tissue defects of the upper or lower extremities or the scalp. We transferred free adipofascial tissue overlying the serratus anterior muscle in three patients and both serratus anterior muscle and adipofascial tissue in four patients. A free adipofascial flap overlying serratus anterior muscle was transferred when a gliding surface was required, owing to the exposure of tendons and neurovascular structures. The average duration from operation to follow-up examination was 8 months (from 4 to 16 months). The results of the operations were satisfactory in functional and cosmetic aspects. This kind of flap was very effective in reconstruction of soft-tissue defects and gliding surfaces for these reasons: easy dissection, the capability of obtaining a long vascular pedicle, large-sized flap, composite flap including muscle or rib, and the fact that there was no serious functional or cosmetic deficit at the donor site.

The Free Serratus Anterior Flap and Its Cutaneous Component for Reconstruction of the Face: A Series of 27 Cases

“…It has been used for reconstruction of defects in the upper limb, 14 -16,21-26 lower limb, 25-36 chest wall, 37-39 lower back and sacrum, 40 and following release of neck contractures. 41,42 In the craniofacial area, it has been used for reconstruction of the scalp/calvaria, 12,26,43,44 cheek and oral lining, 45-47 maxilla, 48,49 mandible, 50 -53 cervical oesophagus, 46 and for facial reanimation. 54 -56 The serratus anterior flap can be used with varying composition of tissue ranging from fascia only, 22,23,57,58 to adipofascial, 26 to muscle, 14 -16,28,37,39 to muscle with bone in the form of either underlying rib 12,21,24,25,31,32,51,56,59 or in conjunction with a scapular bone flap.…”

Dorsal Hand Coverage with Free Serratus Fascia Flap

“…In 1998, Schwabegger et al 5 suggested the term "free serratus fascia flap," and they used it on three hands. In 1999, Kim et al 2 reported the use of the "serratus anterior adipofascial free flap" on the dorsum of the hand with good results. Soon after, in 1999, Fassio et al 6 demonstrated good results with the same flap, now termed the "serratus anterior free fascial flap" (SAFFF), concurrent with Buehler et al 7 in dorsal hand coverage.…”

“…The flap has the advantages of having a constant and long vascular pedicle; it is thin and pliable with gliding properties; it can be combined with muscle and bone; and it has a low donor-site morbidity with a hidden scar and without resultant functional deficit. 1,2,[4][5][6][7]10 Furthermore, the flap does not require positional change during surgery. A mesh split-thickness skin graft can be performed immediately or delayed.…”

“…The fascia overlying the muscle is supplied by the anterior serratus branch or branches of the thoracodorsal vessels, which lie adjacent to the serratus anterior muscle and its supplying long thoracic nerve. [2][3][4] The serratus anterior muscle inserts on the scapula, and palsy will result in wing scapula. The serratus muscle flap, or inclusion of muscle fibers within the free serratus fascia flap, should involve only the lower part of the serratus anterior muscle, in order to diminish donor-site morbidity.…”

“…The serratus muscle flap, or inclusion of muscle fibers within the free serratus fascia flap, should involve only the lower part of the serratus anterior muscle, in order to diminish donor-site morbidity. 2…”