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The vascular territory of the serratus anterior muscle was investigated by injection studies in cadavers. The overlying skin and the ribs were stained only partially. The skin gets its blood supply by so called rami cutanei laterales originating from the intercostal system. The serratus fascia and the muscle can be transplanted safely on its pedicle, the thorakodorsal vessels. The main indication are the muscle transplantation for reconstruction of facial paralysis and as gliding tissue.

Microvascular and free rib grafts were placed in 4.5 cm defects in an edentate mandibular body defect 18 to 28 days after completion of 50 Gy of irradiation from a 60Co source. The animals were sacrificed from two to forty weeks postoperatively and evaluated clinically, radiographically, and histologically. There was a marked difference in the alveolar mucosal viability with the two grafts. Mucosal dehiscence was not observed over any of the microvascular grafts, but was present in seven-eighths of the free grafts. Union of the microvascular bone graft to the host bone occurred within six weeks. In contrast, after six weeks the free graft was sequestered in all the animals. An unexpected finding with both types of graft was the marked subperiosteal bone formation. This bone appeared to be derived from the host bed, stabilizing and bridging the defects bilaterally. The results suggest that radiated periosteum may play an important role in osteogenesis.

Composite intercostal muscle flaps were experimentally used to repair major intrathoracic tracheal defects in the mongrel dog. These composite flaps provided an adequate tracheal lumen with both sufficient mobility and structural stability. Stenosis of the reconstructed trachea was an uncommon finding, but the incidence of early postoperative mortality was high.

Direct anastomosis of the esophagus is the treatment of choice in patients with esophageal atresia. If, however, a long esophageal gap exists, the anastomosis is performed under tension or a staged procedure is anticipated. The aim of this study was to prove that a pedicle musculopleural graft can be used to bridge the two esophageal ends. In 14 dogs through a right thoracotomy, the periosteum of the fifth rib was mobilized and the rib was excised. An intercostal musculopleural flap was created leaving the muscle attached to its vascular pedicle posteriorly with the intercostal vessels and nerve carefully preserved. A tube-like portion including pleural and intercostal muscles was formed from the free part of the graft. A 5 cm segment of the esophagus was excised and the tubular graft was interimposed. Animals were studied 1 month postoperatively with a barium meal that showed free passage through the esophageal neolumen. Peristaltic activity was studied with strain gauges above, below, and at the grafted area. Histologic examination revealed good healing at both anastomotic sites, while esophageal squamous epithelium covered the lumen all over the graft. Survival of the musculopleural pedicle graft seems to be feasible providing that its vascular supply is preserved. It is, thus, suggested that this technique might offer an alternative method in bridging long gaps in esophageal surgery.

The intercostal flap has many uses for torso reconstruction, whether employed as an island flap or a free flap. With modifications, it can be used as a sensory skin flap, or as a compound osteocutaneous flap to restore stability in a chest wall construction, or as a skin flap with a permanent blood supply to provide stable cover after excision of radiation ulcers.

The examination of the coverage of vascular defects with intercostal muscles showed during an observation period of 7 weeks the development of cartilage tissue with thick elastic fiber nettings running between the chondroma.