Mandibular-facial reconstruction with segmentally split serratus anterior composite flaps

Area of Science:

• Plastic Surgery
• Head and Neck Surgery
• Reconstructive Surgery

Background:

• Head and neck defects from cancer or trauma often involve mandible, skin, and oral mucosa loss.
• Restoring these complex defects requires specialized reconstructive techniques.

Purpose of the Study:

• To describe the utility of a composite tissue unit for head and neck reconstruction.
• To highlight the versatility of the subscapular-thoracodorsal vascular system in flap design.

Main Methods:

• Utilizing a composite tissue unit based on subscapular-thoracodorsal vessels.
• Incorporating skin, bone, and muscle from the serratus anterior and latissimus dorsi.
• Employing vascularized segments of the lower serratus muscle and ribs.
• Using skin paddles from cutaneous scapular/parascapular branches or latissimus dorsi flaps.
• Transferring the composite flap as a microvascular free flap or via pedicle transposition.

Main Results:

• The composite flap successfully restores vascularized skeletal structures, oral lining, and skin cover.
• Flap design can be customized to meet specific recipient defect requirements.
• Preservation of innervated muscle segments allows for retained donor motor function.

Conclusions:

• The subscapular-thoracodorsal composite flap is a versatile and effective option for reconstructing extensive head and neck defects.
• This reconstructive approach incorporates advancements in contemporary flap surgery.
• The technique allows for simultaneous restoration of multiple tissue types and functional preservation.