The versatility of the thoracodorsal artery based composite flaps with vascularized rib and a systematic review of the literature

Abstract

Pedicled and free composite flaps derived from the thoracodorsal artery system, including the latissimus dorsi‐rib (LD‐R) and the serratus anterior‐rib (SA‐R) osteo‐muscular or osteo‐myocutaneous flaps, are potential options to address head and neck, thorax, upper and lower extremity bone, and soft tissue defects' reconstruction. We aimed to report our series of LD/SA‐R composite pedicled and free flaps, evaluating outcomes and complications, and to systematically identify all literature reporting results following LD/SA‐rib reconstructions.

Serratus Anterior Muscle Flap for Reconstruction of Extremity Injuries

“…Elia et al 20 treated 47 patients with osteocutaneous loss, the latissimus dorsi muscle flap associated with ribs were used in 13 limbs. The latissimus dorsi flap associated with the serratil muscle flap and ribs in 25 members as a free flap, in nine as a pedicled flap.…”

“…In cases where serratus was also included, they used the fifth and seventh ribs, inform that they prefer to remove intercalated ribs, in order to preserve the stability of the chest. 20 Yamamoto et al 21 prefer the removal of the last ribs that are floating and do not alter the dynamics of the rib cage. In this study we used the anterior seratil muscle flap exclusively for traumatic injuries not very extensive in the extremities, we do not use this flap associated with ribs, or as a functional flap innervated by the long thoracic to restore the function of paralyzed hand muscles.…”

Serratus Anterior-rib Composite Flap Partial Thumb Reconstruction

“…Composite free flaps supplied by the thoracodorsal system have been well described in head and neck and lower extremity defects, but less commonly for hand reconstruction. 1 , 3 The serratus anterior-rib (SR) composite flap has been touted for its reliability, long pedicle, ease of surgical dissection, quantity of bone combined with muscle bulk, and minimal donor site morbidity. Hand and phalangeal reconstruction using the SR flap was first proposed by the Buncke group 20 years ago, where it was employed for first metacarpal reconstruction in two patients successfully.…”

Serratus Anterior-Rib Composite Flap as a Novel Approach for Tracheal Reconstruction

“…There is an unfortunate paucity of data regarding SARCFs, with only a handful of articles reporting detailed outcomes. A systematic review conducted by Elia et al 13 analyzed ten sources encompassing 88 thoracodorsal artery based composite flaps used for reconstructing head and neck defects. This report showed pleural tearing and pneumothorax were the most common complication occurring in 3.53% and 4.79% of flaps, respectively.…”