Free composite myo-osseous flap with serratus anterior and rib: Indications in head and neck reconstruction

✍ Scribed by Charis Ioannides

• Publisher: John Wiley and Sons
• Year: 1998
• Tongue: English
• Weight: 33 KB
• Volume: 20
• Category: Article
• ISSN: 1043-3074
• DOI: 10.1002/(sici)1097-0347(199810)20:7<660::aid-hed15>3.0.co;2-2

✦ Synopsis

With interest we read the paper by Dr. D. Netscher and co-authors on the serratus flaps. 1 It is true that the serratus/latissimus dorsi/rib complex offers a number of versatile composite flaps for reconstruction of various defects. Neoplasms in the head and neck area, trauma of upper and lower extremities, facial reanimation and hemifacial microsomia are some of the indications. 2,3 We have been using the serratus since 1989. Our favorable experience as well as the advantages and versatility of the flaps associated with this muscle have been published previously. 2,3 Small or monocortical mandibular defects can easily be restored with a vascularized rib. Large defects such as the ones described in this paper, however, are better off with either an iliac crest or a fibula flap. The rib has a higher chance of fracture than the iliac crest or the fibula in the head and neck as well as the lower extremities. 2,4 It is not exactly clear why the authors preferred the former to the latter in the first two cases described in this paper. Furthermore, one questions the necessity of the serratus in the third case presented. In our opinion, free bone grafts fair well in similar cases without the use of free tissue transfer. Harvesting of the flap can easily be done in the supine position, making patient repositioning unnecessary, allowing simultaneous twoteam work, and saving time. However, the authors are to be commended for bringing up a versatile composite flap which is probably not used as often as it deserves and which, when indicated, offers excellent reconstructive results.