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

Abstract

The serratus anterior musculocutaneous flap is reliable and particularly well-suited for reconstruction of the face, and has many advantages. The authors speculate that the skin paddle may be vascularized by perforators from the intercostal vessels communicating with the thoracodorsal pedicle through intramuscular choke vessels.

Anatomical variations of the vascular supply of the cutaneous component of the serratus anterior myocutaneous flap: a systematic review

“…She recognized intercostal artery perforators reaching the skin, as well as giving branches to Serratus Anterior during their intramuscular course. However, she did not observe any anastomosis between these muscular branches and the Serratus Artery branch [12].…”

“…The studies included in our review, reported 54 successful flaps with a cutaneous component. The flaps were either pedicled or free and were aimed to reconstruct defects in various anatomic areas, most commonly head and neck defects [6], [9], [11], [12], [25],, [26] (Table IV).…”

“…Interestingly in one study, a cutaneous perforator arising directly from the serratus artery branch and not from the intercostal artery, was found in 25% [16]. The low consistency of these anastomoses does not however correspond to the high success rates of Pittet and Inoue (almost 90% of complete flap survival) [11], [12].…”

“…In that case, blood would not be allowed to run in a retrograde fashion, (serratus artery branch-choke vessels-muscular branch of intercostal perforator-cutaneous branch of intercostal perforator) resulting in flap failure. From a clinical standpoint, it should be noted that Pittet in her surgical technique description highlighted that she paid attention not to damage the intercostal artery perforators with the cautery [12]. Most likely her meticulous harvesting technique preserves greater number of intercostal artery perforators, therefore achieving high success rates.…”

Using the serratus anterior free flap for dynamic facial reanimation: Systematic review

“…Compared to the GMFT, which represents the gold‐standard for dynamic facial reanimation, the SAFF provides similar muscle bulk and a reliable, long neurovascular pedicle. The option for skin paddles 14 , 15 , 16 , 40 , 41 , 42 , 43 and especially the creation of multiple predictable force vectors represent strong arguments for using the SAFF for immediate dynamic facial reanimation after ablative parotid surgery. Some surgeons even argue against the SAFF because of the need of repositioning after ablative surgery and the supposed significant time delay.…”