title: Free serratus anterior artery perforator flap: a case report with an anatomic and radiological study.
abstract: Perforator flaps have become very popular in reconstructive surgery. The thoracodorsal and lateral thoracic artery perforator flaps are highly studied, and successful clinical series have been reported, whereas the literature concerning the lateral intercostal and serratus anterior artery perforator flaps is quite poor and their vascular anatomy needs yet to be clarified. We describe a case of free serratus anterior artery perforator flap for the reconstruction of a dorsal defect of the foot, followed by an anatomic and radiological study. A 17-year-old boy reported a fracture of the first and second metatarsal bone of the left foot, with a dorsal skin defect, due to a motorcycle accident. After the osteosynthesis treatment, a perforator was identified through a handheld Doppler in the lateral chest area and a cutaneous paddle was designed. Retrograde dissection revealed the perforator's direct link to the serratus anterior pedicle. In our knowledge, an elucidated method to preoperatively visualize the perforating vessel of the serratus anterior artery has not yet been described. Thus, an anatomic study on 8 hemithorax and a radiological study on 33 computed tomographic angiographies of the chest were carried out to clarify the vascular anatomy of the serratus anterior artery perforators and to verify the possibility of their preoperative visualization. The authors believe that the serratus anterior artery perforator could be preoperatively investigated, thus making this flap a valuable option when harvesting a perforator flap in the lateral chest area.
authors.affiliation: Department of Medical and Surgical Specialties, Section of Plastic Surgery, University of Catania, Cannizzaro Hospital, Via Messina, 829-95126, Catania, Italy. serenatamburino@hotmail.com.
authors.forename: Serena
authors.initials: S
authors.lastname: Tamburino
authors.affiliation: Department of Hand Surgery, Plastic Surgery, Burn Surgery, CHU University of Bordeaux, Centre François-Xavier-Michelet, Groupe Hospitalier Pellegrin, Place Amélie-Raba-Léon, 33076, Bordeaux, France.
authors.forename: Tiphaine
authors.initials: T
authors.lastname: Menez
authors.affiliation: Department of Hand Surgery, Plastic Surgery, Burn Surgery, CHU University of Bordeaux, Centre François-Xavier-Michelet, Groupe Hospitalier Pellegrin, Place Amélie-Raba-Léon, 33076, Bordeaux, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Laloze
authors.affiliation: Department of Hand Surgery, Plastic Surgery, Burn Surgery, CHU University of Bordeaux, Centre François-Xavier-Michelet, Groupe Hospitalier Pellegrin, Place Amélie-Raba-Léon, 33076, Bordeaux, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Michot
authors.affiliation: Department of Hand Surgery, Plastic Surgery, Burn Surgery, CHU University of Bordeaux, Centre François-Xavier-Michelet, Groupe Hospitalier Pellegrin, Place Amélie-Raba-Léon, 33076, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Paillet
authors.affiliation: Department of Medical and Surgical Specialties, Section of Plastic Surgery, University of Catania, Cannizzaro Hospital, Via Messina, 829-95126, Catania, Italy.
authors.forename: Rosario Emanuele
authors.initials: RE
authors.lastname: Perrotta
authors.affiliation: Department of Hand Surgery, Plastic Surgery, Burn Surgery, CHU University of Bordeaux, Centre François-Xavier-Michelet, Groupe Hospitalier Pellegrin, Place Amélie-Raba-Léon, 33076, Bordeaux, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Casoli
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D005529:Foot Bones / Q000293:injuries*; D018409:Foot Injuries / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods; D018460:Fractures, Comminuted / Q000601:surgery*; D006801:Humans; D008297:Male; D061525:Perforator Flap / Q000098:blood supply* / Q000637:transplantation*; D019651:Plastic Surgery Procedures; D017695:Soft Tissue Injuries / Q000601:surgery*
keywords: Free perforator flap; Free serratus anterior artery perforator flap; Perforator flap