Reconstruction of Scalp and Cranium Defect Utilizing Latissimus Dorsi Musculocutaneous and Serratus Anterior Muscle Free Flaps with Interpositional Anastomosis of T-Shaped Flap Artery

Abstract

The use of a combination musculocutaneous free flap, consisting of a latissimus dorsi flap and a serratus anterior flap, for reconstruction of a large scalp and cranium defect is described. The recipient artery, the superficial temporal artery (STA), was anastomosed to the flap artery, without sacrificing blood flow, by means of a special technique: forming the end of the flap artery into a T shape and interposing it between the two stumps of the transected STA, because the STA was crucial for tissue adjacent to the defect. The flap vein was anastomosed to the external jugular vein with a vein graft. The extensive defect was immediately closed with sutures, and there were no remarkable complications.

The versatility of the serratus anterior free flap in head and neck reconstruction

“…The serratus has been widely described in the literature for reconstruction of the scalp as a composite flap that can include rib for cranial bone defects and latissimus dorsi for additional coverage. 4,[11][12][13][16][17][18]24,25 Overall, both the serratus and the latissimus dorsi flap exhibit excellent healing with overlaid split-thickness skin grafts.…”

Refinement of the myocutaneous anterolateral thigh flap for reconstruction of frontonasal fistula defects

“…The serratus anterior, with its relatively narrow and long muscle structure, is a good option to obliterate a frontonasal fistula. It can be harvested in a supine position and combined with the latissimus dorsi myocutaneous flap or the thoracodorsal artery perforator flap, allowing a chimeric flap design to reconstruct a complex craniofacial defect . However, a 2‐team approach is difficult and winged scapula can happen if the long thoracic nerve is injured.…”

“…It can be harvested in a supine position and combined with the latissimus dorsi myocutaneous flap or the thoracodorsal artery perforator flap, allowing a chimeric flap design to reconstruct a complex craniofacial defect. 20 However, a 2-team approach is difficult and winged scapula can happen if the long thoracic nerve is injured. Although the rectus abdominis and its perforator flap derivatives have also been described for skull reconstruction cases, the inability to utilize its perforator system for performing chimeric options, coupled with the inherent difficulty of molding the muscle component independent of its overlying skin island, is disadvantageous.…”

Double‐free, flow‐through flap reconstruction for complex scalp defects: A case report

“…Alternative methods to cover such large, composite scalp defects include: omental flaps, 5 combined serratus anterior‐LD myocutaneous double flap (same pedicle), 5 muscle‐only free‐flaps in combination with a split thickness skin graft, 6 radial forearm flaps, 3 scapular flaps, 3 LD flaps, 3, 4 and combined latisimus dorsi myocutaneuos and serratus anterior muscle‐rib free flap coupled with vascularized galea transfer. 7 Souter et al 8 alongside Lamberty and Cormack 9 pioneered and publicized the use of free, flow‐through flaps for head and neck reconstruction in 1983.…”