Serratus anterior muscle in composite head and neck flaps

The serratus muscle (SAM) can be raised as an isolated muscular or osteomuscular flap on its nutrient vessels or in combination with a latissimus dorsi (LD) myocutaneous flap on the thoracodorsal pedicle for various reconstructive purposes. The aim of the present is to report on the results achieved after the use of the SAM alone (n = 7) and in combination with an LD (n = 3) after tumor resection or osteoradionecrosis (ORN) in ten patients with defects of the head and neck. One flap was lost due to venous thrombosis. The donor site morbidity was minimal. Emphasis is given on a new indication, namely ORN of the mandible. Short-term results show that the use of the SAM prevents a pathologic fracture in cases of a class IIIa osteoradionecrotic mandible. More extensive use of the SAM flap is advocated.