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5 - Various applicatons of serratus anterior muscle and fascia flap: a clinical experience on 30 patients
Kamuran Zeynep Sevim, Kemal Uğurlu, Arzu Özcan Akçal, Leyla Türkoğlu Kılınç, Semra Karşıdağ
Purpose: Serratus anterior muscle and fascia flap is a reliable and easily malleable flap option for reconstruction of large defects forming after maxillectomies, full thickness defects of the hard palate, or in areas requiring thin coverage as an alternative to temporoparietal fascia flap, parascapular flap or omentum flap. Also due to the digitations of the muscle, this flap may be raised in various situations such as peripheral facial paralysis patients for dynamic functional restoration purposes. Serratus anterior muscle and fascia flap may be raised in combination with other flaps nourished from the subscapular vascular system as composite tissue in order to reconstruct three dimensional defects with minimal donor site morbidity.
Method: A total of 30 patients were reconstructed with free serratus anterior muscle flap, musculocutaneous flap, osteomusculocutaneous flap or serratus fascia flap between years 1998 and 2011. Twelve patients were female and 18 patients were male with ages ranging between 5 to 66 years. In 16 patients, the defects were located in the head and neck area, in 6 patients the defects were located in the lower extremities. Bare serratus anterior muscle flap was utilized in 9 patients, in the other 21 patients the serratus flap was elevated combined with various other flaps of the subscapular system.
Results: Patients were analyzed in the early and late postoperative period in terms of donor site scar, seroma formation and shoulder movements. Functional loss resulting in winging of the scapula due to thoracicus longus nerve damage was also noted.
Conclusion: Serratus anterior muscle and fascia flap is a multivariate, reliable flap choice especially in patients where thin and functional coverage is required. We utilize this flap with great enthusiasm in our clinic due to minimal site morbidity and satisfying functional results.
Keywords: Serratus anterior muscle flap, serratus anterior fascia flap, combined flap, microsurgery
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