The serratus anterior free muscle flap is useful in lower limb reconst
ruction, as it combines a moderate quantity of muscle with a long vasc
ular pedicle. There are known vascular anatomical variations, for exam
ple the blood supply may come from the thoracodorsal pedicle, directly
from the subscapular pedicle or from the axillary artery and vein. We
present a case with a totally independent arterial supply to the flap
from the first intercostal artery, while venous return from the flap
went back as usual to the subscapular pedicle.