Facilitating harvest of the serratus fascial flap with ultrasonic dissection

Upper extremity reconstruction presents a functional and aesthetic challenge in plastic surgery. Exposure of vital structures often requires vascularized soft tissue coverage to achieve primary wound healing and optimize functional results. Specifically, the serratus fascial flap may satisfy the functional and cosmetic requirements for small- to medium-sized soft tissue defects of the upper extremity with limited donor site morbidity. We describe our technique of serratus fascial flap harvest, using the Harmonic SYNERGY curved blade (Ethicon Endo-Surgery, Cincinnati, Ohio).

A 21-year-old, right-hand-dominant, male carpenter and martial arts expert was involved in a motorcycle collision and sustained a left-hand dorsal degloving injury and extensor tendon rupture. Soft tissue reconstruction was performed with a serratus fascial free flap, immediate split-thickness skin graft, and palmaris longus tendon grafts. The flap was harvested with the Harmonic blade, which utilizes ultrasonic energy translated into mechanical energy, thereby allowing dissection and hemostasis simultaneously.

Flap elevation proceeded facilely using the Harmonic curved blade. The patient had no postoperative complications involving his flap or donor site. The closed suction drain in the donor site was removed on postoperative day 3, and the patient was discharged on postoperative day 10. The patient is doing well at 4 months follow-up.

The Harmonic blade may assist in the dissection of the serratus fascial flap by aiding with hemostasis and minimizing surrounding tissue damage. This may reduce flap damage associated with harvesting techniques as well as decrease donor site seroma formation.