Anatomic basis of serratus anterior muscle flap transposition

In order to explore the possibility of serratus anterior muscle (SAM) flap transposition in head, neck and thoracic surgery, we performed an anatomic study including 40 dissections of the muscle's vascular pedicle, the subscapular-thoracodorsal axis, which is a branch of the axillary artery. The SAM is characterized by its location: extending from the anterior and lateral aspect of the thorax to the medial border of the scapula; its easy surgical access; its constant and reliable vascularization by the thoracodorsal artery, a branch of the subscapular artery; its long arc of rotation allowing utilization of the SAM flap in head and neck and mediastinal surgery without microvascular anastomoses; its versatility in comparison with other perithoracic muscles. These considerations prompted us to use the SAM in head and neck reconstructive surgery; chest wall surgery, including chest wall reconstruction following resection for tumor and breast reconstruction; intrathoracic and mediastinal surgery, including reinforcement of high-risk tracheobronchial sutures or anastomoses, management of bronchopleural fistulas and empyema spaces, and repair of tracheo-esophageal fistulas and tracheal or esophageal defects.