Mandibular-facial reconstruction with segmentally split serratus anterior composite flaps

G. R. Tobin, A. Moberg, A. Ringberg, David T. Netscher

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

Oncologic or traumatic head and neck defects with missing mandible, facial skin, and oral mucosa are especially well suited to reconstruction with a composite tissue unit, based on the subscapular-thoracodorsal vessels, that carries any combination of skin, bone, and muscle to restore vascularized skeletal structures, oral lining, and skin cover. The subscapular-thoracodorsal vascular pedicles supply segmentally split units of the lower serratus muscle and ribs on which it originates. Also, one or two skin paddles for cover and lining flaps are carried either by the cutaneous scapular and parascapular branches of the circumflex scapular vessels or by surgically split segments of the latissimus dorsi musculocutaneous flap. The composite flap can be designed in a variety of combinations to meet recipient defect needs and allow retained innervated segments of the component muscles in situ for preservation of donor motor function. The common subscapular-thoracodorsal vascular pedicle can be transferred either as a microvascular free flap or by pedicle transposition through a subpectoral-subplatysmal tunnel to the mandibular-facial defect. This versatile reconstructive unit illustrates many of the refinements of contemporary flap reconstructions.

Original languageEnglish (US)
Pages (from-to)663-672
Number of pages10
JournalClinics in Plastic Surgery
Volume17
Issue number4
StatePublished - Jan 1 1990

ASJC Scopus subject areas

  • Surgery

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