title: Serratus anterior composite flaps for reconstruction of large-area oral and maxillofacial defects: a new neuromuscular flap.
abstract: Large area defects in the maxillofacial field are difficult to restore with sufficient esthetic and functional outcome. This study was to assess the feasibility of using serratus anterior composite flaps for reconstruction of large-area oral and maxillofacial tissue defects and to determine subsequent effects on neuromuscular function. Six patients with severe maxillofacial deformities were treated with serratus anterior composite flaps. The neurovascularized pedicle of each flap retained the long thoracic nerve to supply motor innervation. The long thoracic nerve was anastomosed with a branch of the facial nerve. The remaining fine branches of the facial nerve were separated interfascicularly and intrafascicularly, and then implanted within the border of the serratus anterior muscle. Transplanted flaps survived in all patients without vascular crisis. At the 12-month follow-up examinations, patients were able to close their eyes, wrinkle their forehead, and blow through pursed lips using the reconstructed mimetic muscles. The free serratus anterior composite flap has different digitations of the serratus anterior and motor nerve innervations, which is an attractive choice for reconstruction of large defects of oral and maxillofacial tissue. The nerve anastomosis and facial nerve replantation technique may protect the pedicle from atrophy of the transferred flap. Facial motion can be animated by neurotization or reinnervation in-growth in the neurotized slips of the serratus.
authors.affiliation: State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Tang
authors.forename: Jie
authors.initials: J
authors.lastname: Long
authors.forename: Fan
authors.initials: F
authors.lastname: Feng
authors.forename: Lijuan
authors.initials: L
authors.lastname: Guo
authors.forename: Chao
authors.initials: C
authors.lastname: Gao
authors.forename: Weidong
authors.initials: W
authors.lastname: Tian
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D005150:Facial Hemiatrophy / Q000601:surgery*; D005153:Facial Neoplasms / Q000601:surgery*; D005154:Facial Nerve / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures; D012509:Sarcoma / Q000601:surgery*; D013524:Surgical Flaps / Q000294:innervation*; D055815:Young Adult