Anatomy And Clinical Application Of Lateral Thoracic Flap With Lower Serratus Anterior Muscle

Objective: To study the blood supply,nerves of serratus anterior muscle especially in lower serratus anterior muscle (LSAM) and anatomical characteristics of its lateral thoracic flap(LTP),and introduce the clinical application of lateral thoracic flap which pedicled by the serratus anterior muscle branch of thoracodorsal artery (LSAM).Methods: ()Dissect the serratus anterior muscle of eight (double sides) corpses to observe its morphology, thoracodorsal artery(TA), long thoracic nerve(LTN), the path, branch and distribution of anterial serratus branch,and observe the blood supply and vascular anastomosis of lateral thoracic flap nutrilized by serratus anterior muscle branch and the perforator branch of intercostal artery(PBIA).Inject the blue ink to one fresh corpse, observation coloring range of lateral thoracic skin.Application of 7 patients with serratus anterior muscle branch of thoracodorsal artery as a pedicled lateral thoracic flap with lower parts serratus anterior muscle which were transfered to repair the body skin and soft tissue defects by free or pedicled transfermation.Results: The lower serratus anterior muscle is nutrilized by serratus anterior branches from thoracodorsal artery with diameters (1.7±0.4)mm. The pedicle length of lateral thoracic flap with the lower serratus anterior muscle is (4.2±1.1)cm. The lateral thoracic flap with lower serratus anterior muscle is nutrilized by serratus anterior cutaneous muscle branches and vessel through intercostal arteries and exists rich vascular anastomosis between them. 6 cases of the free lateral thoracic flap with lower serratus anterior muscle were applied clinically via vascular anastomosis, and 1 case of chest skin wounds were applied by a pedicled lateral thoracic flap,and all succeed. In this study,the minimum acreage of the lateral thoracic flap is 4.5cm×8cm and the maximum value is 10.5cm×15cm.Through the follow-up(6～10months),this study showed that appearance of this kind of flap is acceptable and secondary surgical repair is unnecessary. Furthermore, Donor site is obvious and no serratus anterior muscle dysfunction.Conclusion: Lower serratus anterior muscle of lateral thoracic flap exist a length vascular pedicle, a constant anatomical location,a rich blood supply and cutting a larger flp. The flap has its advantages on reconstruction of soft tissue defects.