title: Serratus anterior venous tributary as a second outflow vein in latissimus dorsi free flaps.
abstract: The latissimus dorsi (LD) flap is a large and reliable myocutaneous flap with a consistently long vascular pedicle. However, the limitation of the thoracodorsal pedicle is that it has only one draining vein for anastomosis. We describe a simple technique of recruiting the tributary vein to the serratus anterior and using it as a second draining vein to alleviate congestion in lower limb reconstruction. The serratus anterior venous tributary segment is cut back to an avalvular segment which averages 5 mm in length. Provision of an additional venous outflow to the flap enabled a second venous anastomosis to the short saphenous vein (N = 1), the long saphenous vein (N = 2), a deep vein (N= 1), and to a deep vein via a vein graft (N = 1), respectively. Five patients with degloving injury of the lower extremity of sizes 150 cm(2) (10 × 15 cm) to 260 cm(2) (10 × 26 cm) underwent successful reconstruction using the LD muscle flap with the serratus anterior tributary vein as a second outflow vein. This serratus anterior venous tributary serves as a useful second outflow channel for alleviating venous congestion during lower limb reconstructive surgery and should be routinely preserved as a lifeboat.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
authors.forename: Terence
authors.initials: T
authors.lastname: Goh
authors.forename: Bien-Keem
authors.initials: BK
authors.lastname: Tan
authors.forename: Yee-Siang
authors.initials: YS
authors.lastname: Ong
authors.forename: Winston
authors.initials: W
authors.lastname: Chew
mesh_terms: D000328:Adult; D004954:Esthetics; D005260:Female; D018409:Foot Injuries / Q000601:surgery*; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods*; D014680:Veins / Q000601:surgery*; D020246:Venous Thrombosis / Q000517:prevention & control