Anomalous blood supply to the serratus anterior muscle flap

The serratus anterior free muscle flap is useful in lower limb reconstruction, as it combines a moderate quantity of muscle with a long vascular pedicle. There are known vascular anatomical variations, for example the blood supply may come from the thoracodorsal pedicle, directly from the subscapular pedicle or from the axillary artery and vein. We present a case with a totally independent arterial supply to the flap from the first intercostal artery, while venous return from the flap went back as usual to the subscapular pedicle.