Fig. 8.7. Latissimus dorsi flap pedicle as well as the motor nerve separates into fingers of muscles corresponding to the slips of the serratus. The size of the serratus anterior is 15 x 20 cm2. A musculo-cutaneous flap of 5 x 15 cm2 can be elevated35 (Fig. 8.8).

Flap Harvesting

Fascia flap: The patient is placed in a lateral position, and the arm is elevated 90°. A slightly curved incision is made along the border of the latissimus muscle. Next identify the muscle border and the serratus arcade. Determine if thoracodorsal

Fig. 8.8. Seratus anterior flap.

pedicle is intact and find the entrance points of the motor fibers into the muscle. Outline the flap size on the muscle surface. Release the muscle from thoracic wall. Preserve the three proximal slips to avoid winging of the scapula. The entire muscle is never taken because of the risk of winging of the scapula. Preservation of at least the upper five and preferably six slips and their intervention will decrease or totally eliminate winging of the scapula. Dissect the thoracodorsal pedicle to the length required. Transfer the flap.

Basing the serratus on its blood supply using the thoracodorsal artery makes it possible to elevate a combined latissimus dorsi and serratus anterior flap.41 The ser-ratus is useful as a free flap for coverage or as an innervated functional muscle.

This flap is particularly used for hand reconstruction and for foot and ankle coverage.

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