open access

Vol 81, No 4 (2022)
Review article
Submitted: 2021-09-06
Accepted: 2021-10-13
Published online: 2021-10-26
Get Citation

Anatomical variations of the vascular supply of the cutaneous component of the serratus anterior myocutaneous flap: a systematic review

C. Gakis1, D. Chrysikos1, A. Samolis1, V. Protogerou1, G. Tsourouflis2, T. Troupis1
·
Pubmed: 34699050
·
Folia Morphol 2022;81(4):834-842.
Affiliations
  1. Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Greece
  2. Second Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Greece

open access

Vol 81, No 4 (2022)
REVIEW ARTICLES
Submitted: 2021-09-06
Accepted: 2021-10-13
Published online: 2021-10-26

Abstract

Although appealing from a reconstructive standpoint, the incorporation of the overlying skin in a serratus anterior muscle flap has not yet seen widespread use, due to considerations with its blood supply. In the present study, a systematic review of the literature has been performed, evaluating studies that investigated the vascular anatomy and variations of serratus anterior myocutaneous flap. The anatomy of the cutaneous blood supply, the size of the cutaneous territory, the design of the skin paddle and the reconstructive goals were analysed. The results showed that the main blood supply originates from the intramuscular anastomoses between intercostal artery perforators and the serratus artery branch in the form of choke vessels. Complementary perfusion from true intramuscular vessel anastomoses or from direct serratus artery cutaneous perforators could contribute to the skin blood supply but only in 25% of the cases. The design of the flap is elliptical with its long axis over the harvested muscle slips and maximum width is 6–8 cm. A myocutaneous serratus anterior flap could be applied in a variety of reconstructive fields, most commonly for head and neck defects. A delay procedure would considerably enhance the perfusion of the cutaneous component and improve the overall viability of the flap.

Abstract

Although appealing from a reconstructive standpoint, the incorporation of the overlying skin in a serratus anterior muscle flap has not yet seen widespread use, due to considerations with its blood supply. In the present study, a systematic review of the literature has been performed, evaluating studies that investigated the vascular anatomy and variations of serratus anterior myocutaneous flap. The anatomy of the cutaneous blood supply, the size of the cutaneous territory, the design of the skin paddle and the reconstructive goals were analysed. The results showed that the main blood supply originates from the intramuscular anastomoses between intercostal artery perforators and the serratus artery branch in the form of choke vessels. Complementary perfusion from true intramuscular vessel anastomoses or from direct serratus artery cutaneous perforators could contribute to the skin blood supply but only in 25% of the cases. The design of the flap is elliptical with its long axis over the harvested muscle slips and maximum width is 6–8 cm. A myocutaneous serratus anterior flap could be applied in a variety of reconstructive fields, most commonly for head and neck defects. A delay procedure would considerably enhance the perfusion of the cutaneous component and improve the overall viability of the flap.

Get Citation

Keywords

serratus anterior, flap skin, cutaneous component, blood supply

About this article
Title

Anatomical variations of the vascular supply of the cutaneous component of the serratus anterior myocutaneous flap: a systematic review

Journal

Folia Morphologica

Issue

Vol 81, No 4 (2022)

Article type

Review article

Pages

834-842

Published online

2021-10-26

Page views

4127

Article views/downloads

606

DOI

10.5603/FM.a2021.0111

Pubmed

34699050

Bibliographic record

Folia Morphol 2022;81(4):834-842.

Keywords

serratus anterior
flap skin
cutaneous component
blood supply

Authors

C. Gakis
D. Chrysikos
A. Samolis
V. Protogerou
G. Tsourouflis
T. Troupis

References (27)
  1. Bruck JC, Bier J, Kistler D. The serratus anterior osteocutaneous free flap. J Reconstr Microsurg. 1990; 6(3): 209–213.
  2. Carvey M, Yang G, Hage R. Skin flaps: A novel approach to medical student instruction on integumentary arterial blood supply. Trans Res Anat. 2021; 23: 100104.
  3. Godat DM, Sanger JR, Lifchez SD, et al. Detailed neurovascular anatomy of the serratus anterior muscle: implications for a functional muscle flap with multiple independent force vectors. Plast Reconstr Surg. 2004; 114(1): 21–30.
  4. Gurtner G, Neligan P. Plastic Surgery: Volume 1: Principles, 3rd Ed. Elsevier 2013.
  5. Hamdi M, Spano A, Landuyt KV, et al. The lateral intercostal artery perforators: anatomical study and clinical application in breast surgery. Plast Reconstr Surg. 2008; 121(2): 389–396.
  6. Heitmann C, Guerra A, Metzinger SW, et al. The thoracodorsal artery perforator flap: anatomic basis and clinical application. Ann Plast Surg. 2003; 51(1): 23–29.
  7. Inoue T, Ueda K, Hatoko M, et al. The pedicled extended serratus anterior myocutaneous flap for head and neck reconstruction. Br J Plast Surg. 1991; 44(4): 259–265.
  8. Janik S, Pyka J, Stanisz I, et al. Use of the myocutaneous serratus anterior free flap for reconstruction after salvage glossectomy. Eur Arch Otorhinolaryngol. 2019; 276(2): 559–566.
  9. Janik SJ, Paraszti I, Hirtler L, et al. Design of skin islands for a myocutaneous serratus anterior free flap-An anatomical study and clinical implication for pharyngeal reconstruction after laryngopharyngectomy. Clin Otolaryngol. 2019; 44(3): 227–234.
  10. Kevin C. Chung. Grabb and Smith’s Plastic Surgery. Wolters Kluwer 2019.
  11. Lung K, St Lucia K, Lui F. Anatomy, Thorax, Serratus Anterior Muscles. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021.
  12. Merle M. Grandes pertes de substance de la main. In: Banzet and JM Servant (eds.). Chirurgie lastique, Reconstructive et Esthetique. aris: Flammarion, 1994. Flammarion, Paris 1994: 580.
  13. Mijatović D, Bulić K, Dzepina I, et al. The supply of blood in the skin territory above the lower part of the serratus anterior muscle. Coll Antropol. 2006; 30(3): 543–547.
  14. Miyamoto S, Arikawa M, Kagaya Yu, et al. Septocutaneous thoracodorsal artery perforator flaps: a retrospective cohort study. J Plast Reconstr Aesthet Surg. 2019; 72(1): 78–84.
  15. Palmer JH, Taylor GI. The vascular territories of the anterior chest wall. Br J Plast Surg. 1986; 39(3): 287–299.
  16. Park SO, Chang H, Imanishi N. The free serratus anterior artery perforator flap-A case report and anatomic study. Microsurgery. 2016; 36(4): 339–344.
  17. Perrot P, Duteille F, Leaute F, et al. Étude anatomique et applications cliniques des caractéristiques de la palette cutanée du lambeau libre de grand dentelé. Ann Chir Plast Esthet. 2006; 51(6): 494–498.
  18. Pittet B, Mahajan AL, Alizadeh N, et al. The free serratus anterior flap and its cutaneous component for reconstruction of the face: a series of 27 cases. Plast Reconstr Surg. 2006; 117(4): 1277–1288.
  19. Pu Q, Huang R, Brand-Saberi B. Development of the shoulder girdle musculature. Dev Dyn. 2016; 245(3): 342–350.
  20. Stranix JT, Jacoby A, Lee ZH, et al. Skin paddles improve muscle flap salvage rates after microvascular compromise in lower extremity reconstruction. Ann Plast Surg. 2018; 81(1): 68–70.
  21. Takayanagi S, Tsukie T. Free serratus anterior muscle and myocutaneous flaps. Ann Plast Surg. 1982; 8(4): 277–283.
  22. Tamburino S, Menez T, Laloze J, et al. Free serratus anterior artery perforator flap: a case report with an anatomic and radiological study. Surg Radiol Anat. 2017; 39(8): 837–842.
  23. Taylor GI, Corlett RJ, Dhar SC, et al. The anatomical (angiosome) and clinical territories of cutaneous perforating arteries: development of the concept and designing safe flaps. Plast Reconstr Surg. 2011; 127(4): 1447–1459.
  24. Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987; 40(2): 113–141.
  25. Thomas BP, Geddes CR, Tang M, et al. The vascular basis of the thoracodorsal artery perforator flap. Plast Reconstr Surg. 2005; 116(3): 818–822.
  26. Valasek P, Theis S, Krejci E, et al. Somitic origin of the medial border of the mammalian scapula and its homology to the avian scapula blade. J Anat. 2010; 216(4): 482–488.
  27. Whitney TM, Buncke HJ, Alpert BS, et al. The serratus anterior free-muscle flap: experience with 100 consecutive cases. Plast Reconstr Surg. 1990; 86(3): 481–90; discussion 491.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Grupa Via Medica, Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.: +48 58 320 94 94, faks: +48 58 320 94 60, e-mail: viamedica@viamedica.pl