Reconstruction of complex shallow defects of the extremities with free serratus musculofascial flap*

Background/aim: Thin and flexible flaps are needed for the repair of extremity tissue defects. Serratus fascia flaps are the most suitable options. There are only a few case reports and case series in the literature. We have aimed to increase the success rate by taking the serratus fascia flaps together with some muscle tissue for the repair of extremity tissue defects. Materials and methods: Between 2006 and 2015, 12 free serratus musculofascial flaps FSMFFs were transferred to 11 patients 8 males, 3 females who had tissue shallow defects of the extremities due to different etiologic factors. The mean age was 24.6 years. Hospital records and patient photographs were reviewed and age, sex, etiologic cause, follow-up period, complication, flap success, cosmetic appearance, and functional results of the extremity were examined.Results: The mean follow-up period was 29.5 months 7-109 months . All of the flaps survived fully and no partial or full necrosis was observed. Partial graft loss was encountered in one patient and it was recovered secondarily with wound dressing. A major deficiency was not experienced postoperatively in the functions and movements of the extremities retained. The cosmetic appearance of the operation area was acceptable or fine. The donor areas healed in all the patients without any problems, and the scars were hidden and inconspicuous.Conclusion: In reconstruction of complex shallow defects of the extremities in which a gliding effect is desired, FSMFF may be an ideal option with its advantages as it does not sacrifice a major vessel, does not leave a hidden and short scar, can be harvested in wide dimensions, and allows the use of the surrounding tissues such as the latissimus dorsi muscle and scapular bone.

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  • 1. Jones NF, Jarrahy R, Kaufman MR. Pedicled and free radial forearm flaps for reconstruction of the elbow, wrist, and hand. Plastic and Reconstructive Surgery 2008; 121: 887-898. doi: 10.1097/01.prs.0000299924.69019.57
  • 2. Kalfarentzos E, Ma C, Tian Z, Zhu H, He Y. Clinical application of the dorsalis pedis free flap for reconstruction of oral cancer defects. Journal of Oral and Maxillofacial Surgery 2015; 73: 341-348. doi: 10.1016/j.joms.2014.08.001
  • 3. Xie S, Deng X, Chen Y, Song D, Li K et al. Reconstruction of foot and ankle defects with a superthin innervated anterolateral thigh perforator flap. Journal of Plastic Surgery and Hand Surgery 2016; 50: 367-374.
  • 4. Brent B, Upton J, Acland RD, Shaw WW, Finseth FJ et al. Experience with the temporoparietal fascial free flap. Plastic and Reconstructive Surgery 1985; 76: 177-188.
  • 5. Smith PJ, Ross DA. Tubed radial fascial flap and reconstruction of the flexor apparatus in the forearm. Journal of Hand Surgery 1993; 18: 959-962.
  • 6. Chen HC, el-Gammal TA. The lateral arm fascial free flap for resurfacing of the hand and fingers. Plastic and Reconstructive Surgery 1997; 99: 454-459.
  • 7. Datiashvili RO, Shibaev E, Chichkin VG, Oganesian AR. Reconstruction of a complex defect of the hand with two distinct segments of the scapula and a scapular fascial flap transferred as a single transplant. Plastic and Reconstructive Surgery 1992; 90: 687-694.
  • 8. Wintsch K, Helaly P. Free flap of gliding tissue. Journal of Reconstructive Microsurgery 1986; 2: 143-151.
  • 9. Schwabegger AH, Hussl H, Rainer C, Anderl H, Ninkovic MM. Clinical experience and indications of the free serratus fascia flap: a report of 21 cases. Plastic and Reconstructive Surgery 1998; 102: 1939-1946.
  • 10. Fassio E, Laulan J, Aboumoussa J, Senyuva C, Goga D et al. Serratus anterior free fascial flap for dorsal hand coverage. Annals of Plastic Surgery 1999; 43: 77-82.
  • 11. Flugel A, Kehrer A, Heitmann C, Germann G, Sauerbier M. Coverage of soft-tissue defects of the hand with free fascial flaps. Microsurgery 2005; 25: 47-53.
  • 12. Ulrich D, Fuchs P, Bozkurt A, Pallua N. Free serratus anterior fascia flap for reconstruction of hand and finger defects. Archives of Orthopaedic and Trauma Surgery 2010; 130: 217-222. doi: 10.1007/s00402-009-0845-5
  • 13. Karsidag S, Akcal A, Turgut G, Ugurlu K, Bas L. Lower extremity soft tissue reconstruction with free flap based on subscapular artery. Acta Orthopaedica et Traumatologica Turcica 2011; 45: 100-108. doi: 10.3944/AOTT.2011.2261
  • 14. Meland NB, Weimar R. Microsurgical reconstruction: experience with free fascia flaps. Annals of Plastic Surgery 1991; 27: 1-8.
  • 15. Ferreira MC, Besteiro JM, Monteiro Junior AA, Zumiotti A. Reconstruction of the foot with microvascular free flaps. Microsurgery 1994; 15: 33-36.
  • 16. Ugurlu K, Karsidag T, Akcal A, Karsidag S, Yazar M et al. Bare serratus anterior free flap in the reconstruction of the partial pharyngoesophageal defect. Journal of Craniofacial Surgery 2011; 22: 1010-1012. doi: 10.1097/SCS.0b013e3182101567
  • 17. Ugurlu K, Sacak B, Huthut I, Karsidag S, Sakiz D et al. Reconstructing wide palatomaxillary defects using free flaps combining bare serratus anterior muscle fascia and scapular bone. Journal of Oral and Maxillofacial Surgery 2007; 65: 621- 629.
  • 18. Rowsell AR, Davies DM, Eisenberg N, Taylor GI. The anatomy of the subscapular-thoracodorsal arterial system: study of 100 cadaver dissections. British Journal of Plastic Surgery 1984; 37: 574-576.
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK