FREE COMPOSITE SERRATUS ANTERIOR AND RIB FLAPS FOR TIBIAL COMPOSITE BONE AND SOFT-TISSUE DEFECT

Open fracture in the lower extremity often involves composite bone and soft-tissue defects. For patients with extensive segmental bone defec ts, vascularized fibular transfers can be utilized and are generally a ccepted as one of the best options for reconstruction of intercalary d efects. In some cases, either bilateral tibias and fibulas are fractur ed or the contralateral fibula is traumatically damaged or absent, pre cluding free fibular transfer. If an osteocutaneous fibular nap cannot be used to manage such a defect, a composite serratus anterior and ri b flap may be considered. Nine composite serratus anterior and rib fla ps, with or without latissimus dorsi transfers, were performed in eigh t patients between August, of 1993 and March of 1994. One patient sust ained a left knee disarticulation and underwent reconstruction for a r ight tibial defect. He failed to achieve lower extremity function with in 2 years and was considered a failure. One flap failed, and the pati ent underwent a below-knee amputation. The remaining six patients rece ived seven composite flaps for tibial and calcaneal defects and could ambulate without assistance. Based on this review, we conclude that th e composite serratus anterior and rib flap with optional latissimus do rsi muscle can be used for (1) bilateral tibial fibular fractures, (2) contralateral lower limb amputation with fillet of the amputated leg if the leg is present for harvest, (3) contralateral middle-third frac ture of the fibula, (4) patients in whom iliac bone is not suitable be cause of either a bone defect greater than 10 to 12 cm or previous har vest of bone graft, and (5) extensive composite bone and soft-tissue d efects.