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Optimization of Microsurgery: Improved Coverage of the Latissimus Dorsi Vascular Pedicle With Vascularized Serratus Fascia

Riboh, Jonathan BS*; Nigriny, John MD*; Chong, Alphonsus MD*†; Page, Rohan MD*; Chang, James MD, FACS*†

doi: 10.1097/01.sap.0000226935.52280.19
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The latissimus dorsi free flap is a workhorse for extremity reconstruction. One of its benefits is a long vascular pedicle that spans the zone of injury. However, it may be difficult to adequately cover this pedicle. Direct closure may be too tight, and skin grafting over the pedicle risks exposure if graft take is poor. We report a technique in which the serratus branch of the thoracodorsal artery and its overlying fascia are harvested en bloc with the thoracodorsal artery and latissimus muscle. This provides 2 flaps on a common pedicle that can easily be rotated to allow positioning and insetting. We successfully used this technique in the reconstruction of both upper and lower extremities. The serratus fascia provides excellent padded covering and is a good bed for skin grafting. The versatility of this hybrid flap will allow its use in a range of complex reconstructive procedures.

From the *Division of Plastic and Hand Surgery, Stanford University Medical Center, Stanford, CA; and the †Section of Plastic Surgery, VA Palo Alto HealthCare System, Palo Alto, CA.

Received March 13, 2006 and accepted for publication April 18, 2006.

No financial support to report.

Reprints: James Chang, MD, Division of Plastic and Hand Surgery, Stanford University Medical Center, 770 Welch Road, Palo Alto, CA 94304. E-mail: changhand@aol.com.

© 2007 Lippincott Williams & Wilkins, Inc.