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Detailed Neurovascular Anatomy of the Serratus Anterior Muscle: Implications for a Functional Muscle Flap with Multiple Independent Force Vectors

Godat, David M. M.D.; Sanger, James R. M.D.; Lifchez, Scott D. M.D.; Recinos, René F. M.D., Ph.D.; Yan, Ji-Geng M.D.; Godat, Monica R. M.D.; Ramirez, Carlos E. M.D.; Matloub, Hani S. M.D.

Plastic and Reconstructive Surgery: July 2004 - Volume 114 - Issue 1 - p 21-29
doi: 10.1097/01.PRS.0000129072.11466.C3
Original Articles

A functional muscle free flap with multiple muscle segments that could be oriented independently to produce different force vectors would be beneficial in facial reanimation and upper extremity reconstruction. The serratus anterior muscle has this potential because two or more individual muscle slips can be transferred on a single vascular pedicle. Although serratus anterior muscular anatomy has been studied previously, little attention has been given to the intramuscular anatomy. Muscle slips 5 through 9 (and 10, if present) in 50 specimens from 27 cadavers were studied following intraarterial latex injection. Eight specimens were injected with a radiopaque material (latex/diatrizoate/lead mixture) for x-ray delineation of the intramuscular vascular pattern. Slips 5 through 9 are consistently supplied by a single dominant branch of the thoracodorsal artery and innervated by the long thoracic nerve. Dissection revealed that the long thoracic nerve and its branches invariably follow the artery and divide proximal to the corresponding arterial division. There is a consistent vascular pattern to each muscle slip, in which the serratus artery gives rise to common slip arteries, each of which supplies adjacent muscle slips. The mean length of a muscle slip from its origin on the rib periosteum to the division of the common slip artery is 9.6 cm. These findings imply that the slips may be separated to the level of these common slip arteries, with up to five slips transferred on a single neurovascular pedicle and each slip oriented independently to provide multiple muscle force vectors. With these possibilities, the reconstructive surgeon may be able to restore more natural facial animation and better intrinsic muscle function in the upper extremity.

Milwaukee, Wis.; and Bucaramanga, Colombia

From the Department of Plastic Surgery, Medical College of Wisconsin, and University of Santander. Received for publication April 18, 2003; revised July 21, 2003.

Presented, in part, at the annual meeting of the American Society for Reconstructive Microsurgery, in San Diego, California, January 13 to 15, 2001, and at the 39th Annual Meeting of the Midwestern Society of Plastic Surgeons, in Chicago, Illinois, April 20 to 21, 2001.

James R. Sanger, M.D.

Department of Plastic Surgery, 9200 W. Wisconsin Avenue, Milwaukee, Wis. 53226,

©2004American Society of Plastic Surgeons