Free composite myo-osseous flap with serratus anterior and rib: Indications in head and neck reconstruction

• Published in: Head & neck Vol. 20; no. 2; pp. 106 - 112
• Main Authors: Netscher, David, Alford, Eugene L., Wigoda, Paul, Cohen, Victor
• Format: Journal Article
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 01.03.1998; John Wiley & Sons
• Subjects: Adult; Biological and medical sciences; Bone Transplantation - methods; Bone Transplantation - pathology; Carcinoma, Adenoid Cystic - surgery; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - surgery; Cartilage - anatomy & histology; Cartilage - blood supply; Cartilage - transplantation; Cheek - surgery; Facial Muscles - surgery; Fibula; head and neck reconstruction; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Ilium; Male; Mandible - surgery; Mandibular Diseases - surgery; Mandibular Neoplasms - radiotherapy; Mandibular Neoplasms - surgery; Medical sciences; Microsurgery; Middle Aged; Muscle, Skeletal - anatomy & histology; Muscle, Skeletal - blood supply; Muscle, Skeletal - transplantation; myo-osseous flap; Neck - surgery; Osteoradionecrosis - surgery; Parotid Neoplasms - surgery; Peripheral Vascular Diseases - complications; Reproducibility of Results; rib; Ribs; serratus anterior; Skull - surgery; Skull Fractures - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the upper aerodigestive tract; Surgical Flaps - blood supply; Surgical Flaps - pathology; Thorax; Human; Reconstruction; Indication; Plastic surgery; Male; Result; Case study; Composite flap; Treatment; Advantage; Surgery; Free flap; Head and neck; Adult; Technique
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/(SICI)1097-0347(199803)20:2<106::AID-HED2>3.0.CO;2-6

Background Although the microvascular transfer of the serratus/rib myo‐osseous composite flap has been previously described, the indications for its use in head and neck reconstruction have not been fully explored. Slender and easily contoured, rib bone offers reconstructive advantages over other bone sources under certain circumstances. The serratus/rib myo‐osseous flap can provide vascularized muscle, bone, and cartilage; in combination with the latissimus dorsi muscle, the serratus/rib flap provides additional soft‐tissue bulk on a single thoracodorsal vascular pedicle unrestricted by orientation requirements of the bone. Many orientations of bone and soft tissue are possible. Methods We describe, through three illustrative cases, the indications for this flap, which might include bony, cartilaginous, and soft‐tissue requirements in the retromolar trigone region, large calvarial defects, and large composite full‐thickness cheek and mandibular defects. Conclusions The serratus/rib composite myo‐osseous flap reliably provides vascularized bone of relatively delicate composition which offers advantages in certain reconstructive circumstances. In addition, when combined with latissimus dorsi muscle on a single vascular pedicle, it supplies additional soft‐tissue bulk which can be positioned without being constrained by the bone placement. Finally, this is a useful “backup” supply of vascularized bone when other sources cannot be used due to, for example, inability to use fibula in the face of severe peripheral vascular disease and inability to use iliac crest if this has been previously used as a donor site for nonvascularized free grafts (as in secondary reconstructions). © 1998 John Wiley & Sons, Inc. Head Neck 20: 106–112, 1998.