FREE COMPOSITE MYO-OSSEOUS FLAP WITH SERRATUS ANTERIOR AND RIB - INDICATIONS IN HEAD AND NECK RECONSTRUCTION

Background. Although the microvascular transfer of the serratus/rib my o-osseous composite flap has been previously described, the indication s for its use in head and neck reconstruction have not been fully expl ored. Slender and easily contoured, rib bone offers reconstructive adv antages over other hone sources under certain circumstances. The serra tus/rib myo-osseous flap can provide vascularized muscle, bone, and ca rtilage; in combination with the latissimus dorsi muscle, the serratus /rib flap provides additional soft-tissue bulk on a single thoracodors al vascular pedicle unrestricted by orientation requirements of the bo ne. Many orientations of bone and sofi tissue are possible. Methods. W e describe, through three illustrative cases, the indications for this Rap, which might include bony, cartilaginous, and soft-tissue require ments in the retromolar trigone region, large calvarial defects, and l arge composite full-thickness cheek and mandibular defects. Conclusion s. The serratus/rib composite myo-osseous flap reliably provides vascu larized bone of relatively delicate composition which offers advantage s in certain reconstructive circumstances, In addition, when combined with latissimus dorsi muscle on a single Vascular pedicle, it supplies additional soft-tissue bulk which can be positioned without being con strained by the hone placement. Finally, this is a useful ''backup'' s upply of vascularized bone when other sources cannot be used due to, f or example, inability to use fibula in the face of severe peripheral v ascular disease and inability to use iliac crest if this has been prev iously used as a donor site for nonvascularized free grafts (as in sec ondary reconstructions). (C) 1998 John Wiley & Sons, Inc.