The versatility of the serratus anterior free flap in head and neck reconstruction

Khan, Muhammad Zia; Rodriguez, Laureano Giraldez; Pool, Christopher; Laitman, Benjamin M.; Hernandez, Christopher; Erovic, Boban M.; Teng, Marita S.; Genden, Eric M.; Miles, Brett A.

doi:10.1002/lary.26116

Cited by 28 publications

(33 citation statements)

References 31 publications

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“…So far, the SAFF has been only used as free muscle flap in few cases for reconstruction of pharyngoesophageal defects or as vascularised free muscle flap as a patch during laryngectomy . To our knowledge, this is the first description of a series of myocutaneous SAFF for pharyngeal reconstruction after primary or salvage laryngopharyngectomy.…”

Section: Discussionmentioning

confidence: 98%

“…The SAFF has a great versatility in reconstruction of the head and neck due to easy harvest, low donor site morbidity, constant vascular anatomy with long vascular pedicle and especially due to its pliability . The SAFF has been already used for reconstruction of skull base, scalp, oral cavity or as myocutaneous flap for facial reconstruction .…”

Section: Discussionmentioning

confidence: 99%

“…The serratus anterior free flap (SAFF) was first described in 1982 by Takayanagi and Tsukie for reconstruction of lower limb defects . In the following, the SAFF has found many applications in head and neck reconstruction, including reconstruction of the oral cavity, the scalp, the skull base, craniofacial defects or the oesophagus …”

Section: Introductionmentioning

confidence: 99%

“…The serratus anterior muscle originates anteriorly on the first nine ribs and inserts at the medial border of the scapula . It derives its main vascular supply from the thoracodorsal artery (TDA), representing a branch of the subscapular artery (SA), which in turn originates from the axillary artery (AA) . However, numerous anatomical variations are possible that have been already described in literature.…”

Section: Introductionmentioning

confidence: 99%

“…Particularly for reconstruction of the head and neck, the SAFF offers some significant advantages, including a long and reliable vascular pedicle, the thinness and pliability of the flap, ease of harvest and a low donor site morbidity. Moreover, due to its central localisation, the SAFF has a low risk for peripheral arterial vascular disease . Although the exact extent and localisation of perfused skin paddles for myocutaneous SAFF have not been defined so far, the SAFF has been successfully used as a myocutaneous free flap for the reconstruction of the face, the head and neck or the lower limb …”

Section: Introductionmentioning

confidence: 99%

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Design of skin islands for a myocutaneous serratus anterior free flap—An anatomical study and clinical implication for pharyngeal reconstruction after laryngopharyngectomy

Janik

Paraszti

Hirtler

et al. 2018

Clinical Otolaryngology

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Objectives The main purpose of this study was to evaluate flap size and flap design of skin islands in myocutaneous serratus anterior free flaps (SAFFs) in fresh cadavers and to further investigate whether myocutaneous SAFFs are suitable flaps for pharyngeal reconstruction after laryngopharyngectomy. Methods Dissection and injection of methylene blue were performed in 20 hemithoraces of 13 fresh cadavers to evaluate flap size and location of skin islands. Based on these pre‐clinical data, we performed pharyngeal reconstruction with myocutaneous SAFF in five patients after laryngopharyngectomy. Results Perfused skin paddles were found in all specimens with a mean size of perfused skin islands of 85.6 ± 49.8 cm2. Lengths and widths of skin islands ranged from 10‐21 cm and 6‐20.5 cm respectively. Flap size did not significantly differ between males and females (P = 0.998), left compared to right hemithoraces (P = 0.468) and between paired specimens (P = 0.915). All skin islands were found within the upper 29.3%‐51.7% of hemithorax (calculated from axilla to costal arch), and between latissimus dorsi muscle posteriorly and anterior axillary line anteriorly. Accordingly, myocutaneous SAFFs were used for pharyngeal reconstruction after laryngopharyngectomy in five patients with advanced hypopharyngeal carcinomas. Three patients had uneventful courses, while one patient developed immediate intraoperative flap loss and another patient developed partial necrosis of SAFF on postoperative day 7. Conclusion Skin islands of SAFF have reliable blood supply, which allow harvest of large myocutaneous SAFFs that can be used also for pharyngeal reconstruction after laryngopharyngectomy.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Design of skin islands for a myocutaneous serratus anterior free flap—An anatomical study and clinical implication for pharyngeal reconstruction after laryngopharyngectomy

Janik

Paraszti

Hirtler

et al. 2018

Clinical Otolaryngology

Self Cite

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Serratus anterior muscle free flap for endoscopic reconstruction of large and complex skull‐base defects

Vyskocil

Janik

Faisal

et al. 2021

Int Forum Allergy Rhinol

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

Janik

Marijić

Faisal³

et al. 2022

Head & Neck

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It was the purpose of this study to evaluate the role of the serratus anterior free flap (SAFF) with its long thoracic nerve (LTN) as composite flap for dynamic facial reanimation. A total of 10 studies, published between 2004 and 2021, met inclusion criteria. Clinical data of 48 patients were used for the systematic review and analysis. One to three slips were used, mainly as one‐stage procedures (n = 39; 81.3%), to create different force vectors. Single or double innervated muscle transfers were utilized in 32 (66.7%) and 16 (33.3%) cases with additionally harvested skin paddles in 4 (8.3%) patients. The LTN was mostly anastomosed to the ipsilateral masseteric nerve (45.8%; n = 22) or to remaining facial nerve branches (37.5%; n = 18), while cross‐facial‐nerve‐grafting was rarely used (16.7%; n = 8). The SAFF as composite flap with different force vectors proved to be a good candidate for immediate dynamic facial reanimation after any midface defects.

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The versatility of the serratus anterior free flap in head and neck reconstruction

Abstract: 4. Laryngoscope, 127:568-573, 2017.

Cited by 28 publications

References 31 publications

Design of skin islands for a myocutaneous serratus anterior free flap—An anatomical study and clinical implication for pharyngeal reconstruction after laryngopharyngectomy

Design of skin islands for a myocutaneous serratus anterior free flap—An anatomical study and clinical implication for pharyngeal reconstruction after laryngopharyngectomy

Serratus anterior muscle free flap for endoscopic reconstruction of large and complex skull‐base defects

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

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