SERRATUS ANTERIOR INTERCOSTAL NERVE GRAFT - A NEW VASCULARIZED NERVE GRAFT

We present our investigative and clinical experience with a new vascul arized nerve graft: the serratus anterior intercostal nerve graft. The serratus branch of the thoracodorsal arterial system was injected wit h silicone rubber injection compound in seven fresh cadavers (N = II i njected specimens) after the;composite serratus-intercostal structures were harvested. Microdissection of selected vascular territories was then performed. Our findings reconfirmed the previously described vasc ular connections between the thoracodorsal system and the intercostal vessels via periosteal vessels. We also newly discovered vascular anas tomoses between the serratus anterior muscle and the intercostal arter y running within a mesentery. This mesentery is lateral to and distinc t from the serratus-periosteal-intercostal network. The nerve graft wa s applied clinically in the reconstruction of a complex soft-tissue, 1 3-cm ulnar nerve defect of the volar forearm after an electrical injur y. The clinical application was successful with limb salvage and retur n of protective sensation at 4 months. Our clinical and investigative results support the feasibility of the serratus anterior intercostal n erve graft, a unique and versatile new vascularized nerve graft.