Free serratus anterior artery perforator flap: a case report with an anatomic and radiological study

Abstract

Perforator flaps have become very popular in reconstructive surgery. The thoracodorsal and lateral thoracic artery perforator flaps are highly studied, and successful clinical series have been reported, whereas the literature concerning the lateral intercostal and serratus anterior artery perforator flaps is quite poor and their vascular anatomy needs yet to be clarified. We describe a case of free serratus anterior artery perforator flap for the reconstruction of a dorsal defect of the foot, followed by an anatomic and radiological study. A 17-year-old boy reported a fracture of the first and second metatarsal bone of the left foot, with a dorsal skin defect, due to a motorcycle accident. After the osteosynthesis treatment, a perforator was identified through a handheld Doppler in the lateral chest area and a cutaneous paddle was designed. Retrograde dissection revealed the perforator's direct link to the serratus anterior pedicle. In our knowledge, an elucidated method to preoperatively visualize the perforating vessel of the serratus anterior artery has not yet been described. Thus, an anatomic study on 8 hemithorax and a radiological study on 33 computed tomographic angiographies of the chest were carried out to clarify the vascular anatomy of the serratus anterior artery perforators and to verify the possibility of their preoperative visualization. The authors believe that the serratus anterior artery perforator could be preoperatively investigated, thus making this flap a valuable option when harvesting a perforator flap in the lateral chest area.

Anatomical variations of the vascular supply of the cutaneous component of the serratus anterior myocutaneous flap: a systematic review

“…The author attributed this to the radiological protocol used, since the samples had been derived from CT chest angiographies of patients suspected for pneumonic embolism. She believes that a special radiological protocol would have probably revealed more perforators [16], (Table II).…”

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

“…Although Merle et al stated that the use of SAFF as myocutaneous free flap might be impossible due to lack of skin perforators, several authors independently demonstrated direct connections between TDA and intercostal perforators to the skin . Pittet et al (2006) first described boundaries for the harvest of skin islands of myocutaneous SAFF for facial reconstruction.…”

“…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 …”

“…6 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, 2 the head and neck 12 or the lower limb. 13 Hence the main purpose of the study was to perform an anatomical study in order to evaluate the optimal area and size for the harvest of skin islands perfused by the thoracodorsal artery and to define applicable recommendations for clinical routine. Based on these pre-clinical data, we additionally report on our first clinical experiences of pharyngeal reconstruction using a myocutaneous SAFF after laryngopharyngectomy.…”

The Flap Based on the Subscapular Artery: A Cross-sectional Study

“…The proportion of branched samples should be clearer about arteries in that muscle (1,6). Serratus anterior muscle flaps have not been widely studied, particularly in Vietnam (7)(8)(9)(10). The vascular branches entering the serratus anterior muscle are often varied regarding quantum and origin; additional data on this aspect are needed if these differences are clinically significant.…”