Regarding the use of the serratus anterior muscle pedicle as recipient vessels in DIEP flap breast reconstruction

Abstract

We read with great interest the letter from Chaput et al. regarding the use of the serratus anterior muscle pedicle as recipient vessels in DIEP flap breast reconstruction. The national comparative audit of mastectomy and breast reconstruction surgery in England 2 included 476 cases of immediate free flap breast reconstruction and 566 cases of delayed free flap breast reconstruction. The overall free flap failure rate was 1.98%. In our own department the total failure rate is 0.48% for free flap breast reconstruction (unpublished data). Chaput et al. reported a significantly higher flap failure rate of 19% using this technique, although Santanelli di Pompeo reports a much higher success rate. We have not adopted this technique in our department, but broadly agree with the advantages and disadvantages previously proposed. We feel that this pedicle may have value in a salvage scenario, as reported by Caulfield et al. However, we would only adopt it with caution based on these contrasting reports. Yours sincerely.