Intrathoracic transposition of the serratus anterior muscle flap--personal experience with 65 consecutive patients.
OBJECTIVE
The objective of our article is to analyse the results of intrathoracic transposition of the serratus anterior (SA) muscle flap for suppurative diseases.


METHODS
We performed a retrospective analysis of 65 consecutive patients operated upon in our unit between 1 January 2003 and 1 March 2009 in whom we used intrathoracic transposition of the SA muscle flap. The flap was used alone or in association with other flaps and/or thoracoplasty in patients not amenable to lung resection and/or decortication, including tuberculous (TB) lesions in 30 patients (46%), postoperative empyema in 12 patients (18%), frank intrapleural rupture of a pulmonary cavity in 13 patients (20%) and bronchial fistula(e) in 26 patients (40%). Many patients presented a combination of the afore-mentioned anatomo-clinical characteristics. The SA was used alone in 16 patients (25%) and in combination with other flaps in 49 patients (75%). In most cases (62 patients, 95%), the flap was mobilised using both the thoracodorsal branch and the lateral thoracic vessels. Associated limited rib resection was performed with an average of 4.9±1.6 resected ribs per patient.


RESULTS
In general, mortality was 5% (three patients) and other two patients (3%) presented recurrence of the intrathoracic infection requiring re-operation; minor local complications were encountered in three patients (skin necrosis--two cases and external thoracic fistula--one case). Postoperative hospitalisation ranged between 4 and 172 days, with a median of 34 days. We encountered a mild impairment of shoulder mobility in five patients, but no case of true-winged scapula. Analysis of the pre- and postoperative values of the vital capacity (VC) and forced expiratory volume in 1s (FEV1) showed no statistically significant difference (paired t test -p>0.05).


CONCLUSIONS
The SA muscle flap is very well suited for intrathoracic transposition. Its use is not associated with significant postoperative morbidity.
Botianu
Petre Vlah-Horea
PV
Surgical Clinic 4 University of Medicine and Pharmacy, Targu-Mures, Romania. botianu_petre@yahoo.com
Botianu
Alexandru Mihail
AM
Dobrica
Adrian Cristian
AC
Bacarea
Vladimir
V
D000328:Adult; D001983:Bronchial Fistula / Q000601:surgery; D016724:Empyema, Pleural / Q000601:surgery; D005260:Female; D005541:Forced Expiratory Volume; D006085:Graft Survival; D006801:Humans; D007432:Intraoperative Period; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D012189:Retrospective Studies; D013492:Suppuration / Q000601:surgery; D013524:Surgical Flaps; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D014397:Tuberculosis, Pulmonary / Q000601:surgery; D014797:Vital Capacity