Using the serratus anterior free flap for dynamic facial reanimation: Systematic review

Head Neck. 2023 Jan;45(1):266-274. doi: 10.1002/hed.27219. Epub 2022 Oct 19.


It was the purpose of this study to evaluate the role of the serratus anterior free flap (SAFF) with its long thoracic nerve (LTN) as composite flap for dynamic facial reanimation. A total of 10 studies, published between 2004 and 2021, met inclusion criteria. Clinical data of 48 patients were used for the systematic review and analysis. One to three slips were used, mainly as one-stage procedures (n = 39; 81.3%), to create different force vectors. Single or double innervated muscle transfers were utilized in 32 (66.7%) and 16 (33.3%) cases with additionally harvested skin paddles in 4 (8.3%) patients. The LTN was mostly anastomosed to the ipsilateral masseteric nerve (45.8%; n = 22) or to remaining facial nerve branches (37.5%; n = 18), while cross-facial-nerve-grafting was rarely used (16.7%; n = 8). The SAFF as composite flap with different force vectors proved to be a good candidate for immediate dynamic facial reanimation after any midface defects.

Keywords: ablative midface surgery; composite flap; dynamic facial reanimation; parotidectomy; serratus anterior free flap.

Publication types

  • Systematic Review
  • Review

MeSH terms

  • Face / surgery
  • Facial Nerve / surgery
  • Facial Paralysis* / surgery
  • Free Tissue Flaps* / transplantation
  • Humans
  • Nerve Transfer* / methods
  • Plastic Surgery Procedures*