Abstract
ObjectivesThe main purpose of this study was to evaluate flap size and flap design of skin islands in myocutaneous serratus anterior free flaps (SAFFs) in fresh cadavers and to further investigate whether myocutaneous SAFFs are suitable flaps for pharyngeal reconstruction after laryngopharyngectomy.MethodsDissection and injection of methylene blue were performed in 20 hemithoraces of 13 fresh cadavers to evaluate flap size and location of skin islands. Based on these pre‐clinical data, we performed pharyngeal reconstruction with myocutaneous SAFF in five patients after laryngopharyngectomy.ResultsPerfused skin paddles were found in all specimens with a mean size of perfused skin islands of 85.6 ± 49.8 cm2. Lengths and widths of skin islands ranged from 10‐21 cm and 6‐20.5 cm respectively. Flap size did not significantly differ between males and females (P = 0.998), left compared to right hemithoraces (P = 0.468) and between paired specimens (P = 0.915). All skin islands were found within the upper 29.3%‐51.7% of hemithorax (calculated from axilla to costal arch), and between latissimus dorsi muscle posteriorly and anterior axillary line anteriorly. Accordingly, myocutaneous SAFFs were used for pharyngeal reconstruction after laryngopharyngectomy in five patients with advanced hypopharyngeal carcinomas. Three patients had uneventful courses, while one patient developed immediate intraoperative flap loss and another patient developed partial necrosis of SAFF on postoperative day 7.ConclusionSkin islands of SAFF have reliable blood supply, which allow harvest of large myocutaneous SAFFs that can be used also for pharyngeal reconstruction after laryngopharyngectomy.
Highlights
The serratus anterior free flap (SAFF) was first described in 1982 by Takayanagi and Tsukie for reconstruction of lower limb defects.[1]
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 report on our first clinical experiences of pharyngeal reconstruction using a myocutaneous SAFF after laryngopharyngectomy
The specimens were obtained from voluntary donors who consented during lifetime to donate their body for research and teaching purpose to the Center for Anatomy and Cell Biology at the Medical University of Vienna
Summary
The serratus anterior free flap (SAFF) was first described in 1982 by Takayanagi and Tsukie for reconstruction of lower limb defects.[1]. The serratus anterior muscle originates anteriorly on the first nine ribs and inserts at the medial border of the scapula.[6] It derives. Its main vascular supply from the thoracodorsal artery (TDA), representing a branch of the subscapular artery (SA), which in turn originates from the axillary artery (AA).[6] numerous anatomical variations are possible that have been already described in literature. Vascular supply can directly arise from the AA,[8] the intercostal artery[9,10] or the lateral thoracic artery.[2,11]
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