The Serratus Anterior Free Tissue Transfer for Total Laryngectomy and Craniofacial Defect Reconstructions

Abstract

Objectives: (1) Describe the method of harvesting and recognize the versatility of the serratus anterior free flap. (2) Review the use of the serratus anterior free flap for reconstruction after total laryngectomy and for craniofacial defects. Methods: Retrospective case review of 7 cases performed at a single tertiary care institution. PubMed literature review of serratus anterior free flap reconstruction from 1966 to present. Results: In the 4 patients in whom the serratus anterior free flap was used to reconstruct a total laryngectomy defect, no postoperative wound infections or salivary leaks were identified. The serratus free flap proved to be an effective means of reconstructing the skull base in 2 cases as well as covering a large scalp defect in a third case. Conclusions: This case series illustrates the benefit of muscle coverage in head and neck reconstruction in both the isolation of the nasal cavity from the intracranial cavity after craniofacial resection and in patients at risk of fistula formation after total laryngectomy. The serratus anterior flap was selected because of its ease of harvest, relatively low donor site morbidity, and adequate bulk. The patients who underwent total laryngectomy did not have evidence of leak, and adequate carotid artery coverage was achieved. Similarly, the craniofacial resection patients achieved adequate cranio-nasal separation and effective coverage of a large scalp defect. The use of a serratus anterior free flap proved to be an excellent choice in the reconstruction of the defects in this series with minimal postoperative morbidity related to both the reconstructive and donor sites.