Serratus anterior free flap in oral reconstruction

J Oral Maxillofac Surg. 2009 Dec;67(12):2577-82. doi: 10.1016/j.joms.2009.07.045.


Purpose: Perforating oral and maxillofacial defects frequently cause severe functional disorders. Microvascular free flaps like the radial forearm flap and the latissimus dorsi flap have been described to cover those defects; however, harvest of the radial forearm flap causes remarkable donor-site morbidity, while the latissimus dorsi flap often turns out to be too bulky. Therefore we introduce the serratus anterior muscle as a versatile and reliable microvascular flap to cover defects of both the floor of the mouth and the maxilla.

Patients and methods: Between 2003 and 2007, 10 oral defects were reconstructed using the serratus anterior flap. In 5 of the cases, the defects were located at the hard palate and maxilla, while in the other cases they were located in the floor of the mouth.

Results: All of the patients were able to feed orally within the first week postoperatively. Donor-site morbidity was observed to be negligible not least because of the achievement of primary tension-free wound closure. Successful reconstruction could be observed in 8 of 10 patients.

Conclusion: Although the serratus anterior muscle flap lacks an epithelial layer, this flap is not restricted to a subcutaneous placement. Due to rapid epithelialization, the serratus anterior muscle is even suitable for perforating intraoral defects.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mouth Neoplasms / surgery*
  • Oral Surgical Procedures / methods*
  • Reconstructive Surgical Procedures / methods*
  • Surgical Flaps* / blood supply