Anomalous arterial supply to the muscles in a combined latissimus dorsi and serratus anterior flap

Abstract

The combined latissimus dorsi and serratus anterior flap has been employed for large defect reconstruction and has been shown to be reliable. These flaps are based on the subscapular-thoracodorsal vascular pedicle that usually supplies both muscles. In the case reported, serratus anterior possessed an anomalous arterial supply totally independent of the subscapular pedicle. The latissimus dorsi and serratus anterior muscles were used as a combined flap to reconstruct a massive thigh defect. The combined flap required two arterial anastomoses.

A Case of Latissimus Dorsi Pedicle Arising from the Lateral Thoracic Vessels

“…Our previously published experience shows that the origin of the collateral branch is not constant 10 and may come from the subscapular artery. Others reported no connection of the pedicle of the serratus anterior to the subscapular tree whatsoever, 11,12 taking its origin from the second part of the axillary artery or an intercostal artery, respectively.…”

Regarding the vascular anatomy of muscles with a special focus on the gracilis muscle

“…The recent years, studies in clinical anatomy have produced valuable information on specific vascularization of the anatomical structures used in these flaps (Saadeh et al, 1998;Fróes et al, 1999;Traxler et al, 1999;Tao et al, 2000;Halim and Wan, 2004;Macchi et al, 2008Macchi et al, , 2009Rozen et al, 2008Rozen et al, , 2009Rozen et al, , 2010Rozen et al, , 2011Ger, 2009;Ma et al, 2009;Papadimas et al, 2009;Beer and Manestar, 2010;Piquilloud et al, 2011;Janus et al, 2012).…”