13.5.

3 SERRATUS ANTERIOR MUSCLE FLAP Look up Takayanagi, Tsukie 1982

Anatomy Lateral thoracic a (off 2nd part of axillary a) supplies upper part , thoracic branch of thoracodorsal supplies the lower part Type !!!, Two do"inant pedicles 1st 9 ribs to angle of scapula #pper slips $ %&, next 2 %' Lower slips %( all fro" Long Thoracic )er*e+ Long thoracic ) lies anterior to the artery but still deep to the deep fascia, ,oining the artery at the le*el of the 'th rib+ Lower slips ((-8-9th ribs) ha*e an independent ner*e and blood supply .essels enter at the ,unction of the "iddle and post third of the "uscle+ !nserts$ angle of scapula+ /cts $ protrusion of the scapula and rotation of scapula upwards and outwards pre*ents winging of scapula

Surface Mark n!" !ncision 0arallels the 8th rib on the lateral chest sidewall cur*ing superiorly into axilla+

Ty#e of f$a# Type !!! $ 2 do"inant pedicles 1 lateral thoracic and serratus br of thoracodorsal 2yocutaneous 2yo-osseous (with rib) 2yo-osseocutaneous

Common u"e" 3ead and neck recon 4ace and 3and reani"ation %lose of extre"ity soft tissue defects

Tec%n &ue !dentify the anterior border of L5 and raise this "uscle off the underlying serratus in its posterior part+ /nt part exposed by ele*ation of the o*erlying skin+ 6le*ate the lower slips of serratus off their rib origins, tie off "ultiple intercostal perforators unless skin or bone re7uired+ Trace pedicle superiorly 0reser*e the long thoracic ner*e unless inner*ated "uscle is needed $ can then separate out a discrete bunch of fascicles to the lower part of the "uscle only (ner*e graft can be inserted) Tie off the thoracodorsal branch to L5 and the circu"flex scapular if need *ery long pedicle (whole of subscapular artery)

Ot%er Po nt" 6asy to split Long 0edicle so less likely to need *ein grafts+ 'o( to Ra "e t%e F$a#)

Last printed /var/www/apps/conversion/tmp/scratch_6/202499212.doc

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Patient positioning and skin incision

Retraction of latissimus dorsi & expose vessels and nerves

Last printed /var/www/apps/conversion/tmp/scratch_6/202499212.doc

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Divide branches of pedicle to upper slips

Re$ea"e t%e f$a#

Last printed /var/www/apps/conversion/tmp/scratch_6/202499212.doc

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