J Reconstr Microsurg 2011; 27(8): 469-474
DOI: 10.1055/s-0031-1284231
© Thieme Medical Publishers

Serratus Anterior Venous Tributary as a Second Outflow Vein in Latissimus Dorsi Free Flaps

Terence Goh1 , Bien-Keem Tan1 , Yee-Siang Ong1 , Winston Chew2
  • 1Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
  • 2Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
Further Information

Publication History

Publication Date:
27 July 2011 (online)

ABSTRACT

The latissimus dorsi (LD) flap is a large and reliable myocutaneous flap with a consistently long vascular pedicle. However, the limitation of the thoracodorsal pedicle is that it has only one draining vein for anastomosis. We describe a simple technique of recruiting the tributary vein to the serratus anterior and using it as a second draining vein to alleviate congestion in lower limb reconstruction. The serratus anterior venous tributary segment is cut back to an avalvular segment which averages 5 mm in length. Provision of an additional venous outflow to the flap enabled a second venous anastomosis to the short saphenous vein (n = 1), the long saphenous vein (n = 2), a deep vein (n = 1), and to a deep vein via a vein graft (n = 1), respectively. Five patients with degloving injury of the lower extremity of sizes 150 cm2 (10 × 15 cm) to 260 cm2 (10 × 26 cm) underwent successful reconstruction using the LD muscle flap with the serratus anterior tributary vein as a second outflow vein. This serratus anterior venous tributary serves as a useful second outflow channel for alleviating venous congestion during lower limb reconstructive surgery and should be routinely preserved as a lifeboat.

REFERENCES

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Bien-Keem TanM.B. B.S. F.R.C.S F.A.M.S. 

Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital

Outram Road, Singapore 169608

Email: bienkeem@singnet.com.sg

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