The free serratus anterior flap and its cutaneous component for face reconstruction: a series of 27 cases

The serratus anterior flap is commonly used without its cutaneous component and is covered with a skin graft. We have successfully used the free serratus anterior flap along with its skin paddle and have found it to be valuable for reconstruction of the face. We have done fresh cadaveric dissections and arteriography to identify perforator vessels to the skin overlying the muscle. Clinically, free transfer of the musculocutaneous flap to the face was carried out in 27 patients, mostly for severe noma (infection) sequellae. Anatomical dissection and arteriography revealed no cutaneous perforator vessels directly communicating with the vascular pedicle of the muscle. However, large perforators from the intercostal vessels were found passing through the muscle to reach the skin. In the clinical cases, flap survival was 100% in 24 patients. The serratus anterior musculocutaneous flap is reliable and particularly well-suited for reconstruction of the face with many advantages. We speculate that the skin paddle may be vascularised by perforators from the intercostal vessels communicating with the thoracodorsal pedicle through intramuscular choke vessels.