Versatility of the Serratus Anterior Free Flap in Limb Reconstruction: 50 Cases

The authors reported a retrospective series of 50 serratus anterior free flaps carried out in their unit for limb reconstruction, from March 2001 to December 2004.

Fifty free flaps of serratus anterior were carried out in 48 patients, by the same surgeon, for reconstructive surgery of the limbs. There were 40 men and 8 women, of average age 34.2 years (5–64 years). The flaps were used for reconstruction of the lower limb in 47 cases (94%) and of the upper limb in 3 cases (6%). The flaps were indicated for repair of traumatic soft tissue defect (88%), for purpura fulminans (6), for deep burn (4%) and after tumor resection (2%).

Four different types of serratus anterior flaps were used: muscular (58%), osteomuscular (30%), fascial (10%), or combined with latissimus dorsi (2%). A skin paddle was used in 24% of the cases.

The average size of the flap was 95 cm² (18–180). In the 15 cases of osteomuscular flaps, an osteo flap (8th rib) was used, in order to correct a bone defect, which ranged from 4 to 15 cm.

Of 50 free serratus anterior flaps, 8 early surgical recoveries were necessary. On the whole, necrosis occurred in 4 flaps (8%). The functional outcome was good for all patients and the aesthetic sequelae at the donor site were considered as minor.

The serratus anterior free flap has many advantages (length of pedicle, remarkable smoothness, great malleability). It can be used in many different ways: in different kinds of tissues (muscle, bone, fascia, skin); has a very variable size of flap; and different lengths of pedicle are possible. Because of its versatility and its absence of major functional or aesthetic sequelae, the serratus anterior free flap has become a favorite option in limb reconstruction.