Reconstruction of soft tissue defects using free serratus anterior muscle and adifofascial flap

Chung, Yoon Jae; Kwon, Taek Keun; Cha, Jin Han; Kim, Yang Woo

Abstract

The optimal reconstruction of soft tissue defects with exposure of blood vessel, nerve, tendon muscle, and bone requires muscle flap that provides a durable surface, appropriate bulk and stability. The serratus anterior muscle has been suggested as a versatile and reliable flap for reconstruction of head and neck and extremity injuries. In our department, reconstructive operations were performed for 18 patients who had soft tissue defect of upper or lower extremities or head from March 1995 to February 1996. We performed free flap of serratus anterior muscle in 13 patients, free flap of adipofascial tissue overlying serratus anterior muscle in 3 patients, free flap of both serratus anterior muscle and adipofascial tissue in 1 patient, free flap of serratus anterior muscle and rib in 1 patient. Their ages were 5 to 56 years, the ratio of male to female was 14 : 4. The defects involved the upper extremity in 6 patients, lower extremity in 10 patients, and scalp in 2 patients. Free flap using adipofascia overlying serratus anterior muscle was performed when gliding surface was required due to the exposure of some structure such as tendon. The average duration from operation to follow-up examination was 4 months(from 1 to 12 months). One total necrosis was observed in the patient who had crushing injury of forearm, and one partial necrosis was observed in other patient. In the rest 16 cases, results of operation were satisfactory. This kind of flap was very useful in reconstruction of soft tissue defect and gliding surface due to easy dissection, capability of getting long vascular pedicle, and no serious functional and cosmetic deficit on donor site.