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Anatomic basis of serratus anterior muscle flap transposition

Bases anatomiques de la transposition du m. grand dentelé

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Summary

In order to explore the possibility of serratus anterior muscle (SAM) flap transposition in head, neck and thoracic surgery, we performed an anatomic study including 40 dissections of the muscle's vascular pedicle, the subscapular-thoracodorsal axis, which is a branch of the axillary artery. The SAM is characterized by its location: extending from the anterior and lateral aspect of the thorax to the medial border of the scapula; its easy surgical access; its constant and reliable vascularization by the thoracodorsal artery, a branch of the subscapular artery; its long arc of rotation allowing utilization of the SAM flap in head and neck and mediastinal surgery without microvascular anastomoses; its versatility in comparison with other perithoracic muscles. These considerations prompted us to use the SAM in head and neck reconstructive surgery; chest wall surgery, including chest wall reconstruction following resection for tumor and breast reconstruction; intrathoracic and mediastinal surgery, including reinforcement of high-risk tracheobronchial sutures or anastomoses, management of bronchopleural fistulas and empyema spaces, and repair of tracheo-esophageal fistulas and tracheal or esophageal defects.

Résumé

Les possibilités de la transposition du muscle grand dentelé en chirurgie cervico-faciale et thoracique sont démontrées par une étude anatomique comprenant 40 dissections de son pédicule vasculaire dépendant de l'artère axillaire, et en particulier de l'axe scapulaire inférieur-thoraco-dorsal. Ce muscle est remarquable par sa situation: de la face antérolatérale du thorax au bord spinal de la scapula; son accès chirurgical relativement aisé; sa vascularisation: constante et fiable, dominée par l'artère thoraco-dorsale venant de l'a. scapulaire inférieure; l'axe de rotation du lambeau musculaire est compatible avec l'utilisation du lambeau du m. grand dentelé à l'étage cervico-facial ou médiastino-pulmonaire sans micro-anastomose vasculaire; sa souplesse et malléabilité par rapport à d'autres muscles périthoraciques. Ces propriétés permettent l'utilisation du m. grand dentelé en chirurgie reconstructive cervico-faciale; au niveau thoracique pariétal, incluant les reconstructions pariétales après exérèse et les plasties mammaires; au niveau intrathoracique et médiastinal, incluant la protection première des sutures ou anastomoses trachéobronchiques à haut risque, le traitement des fistules broncho-pleurales et comblement des cavités d'empyèmes et les pertes de substance trachéale, œsophagienne ou mixtes; de même pour les fistules.

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References

  1. Arnold PG, Pairolero PC, Waldorf JC (1984) The serratus anterior muscle: intrathoracic and extrathoracic utilization. Plast Reconstr Surg 73: 240–248

    PubMed  Google Scholar 

  2. Barker WL, Faber LP, Ostermiller WE, Langston HT (1971) Management of persistent bronchopleural fistulas. J Thorac Cardiovasc Surg 62: 393

    PubMed  Google Scholar 

  3. Bartlett SP, May JW, Yaremchuk MJ (1981) The latissimus dorsi muscle: a fresh cadaver study of the primary neurovascular pedicle. Plast Reconstr Surg 67: 631–636

    PubMed  Google Scholar 

  4. Baudet J, Guimberteau JC, Nascimento E (1976) Successful clinical transfer of 2 free thoraco-dorsal axillary flaps. Plast Reconstr Surg 58: 680–688

    PubMed  Google Scholar 

  5. Bergman J, Monties R (1960) L'abord postéro-latéral de la cage thoracique avec dissection du grand dentelé, technique de routine. Ann Chir 14: 405–412

    PubMed  Google Scholar 

  6. Bharikoke V, Gupta M (1986) Muscular attachments along the medial border of the scapula. Surg Radiol Anat 8:71

    PubMed  Google Scholar 

  7. Cabanie H, Garbe JF, Guimberteau JC (1980) Anatomical bases of the thoraco-dorsal axillary flap with respect to its transfer by means of microvascular surgery. Anat Clin 2: 65–73

    Google Scholar 

  8. Chang N, Mathes SJ (1982) Comparison of the effect of bacterial inoculation in musculocutancous and random-pattern flaps. Plast Reconstr Surg 70: 1–9

    PubMed  Google Scholar 

  9. Chicarilli ZN, Ariyan S, Glenn WWL, Seashore JH (1985) Management of recalcitrant bronchopleural fistulas with muscle flap obliteration. Plast Reconstr Surg 75: 882–887

    PubMed  Google Scholar 

  10. De Coninck A, Boeckx W, Vanderlinden E, Claessen G (1975) Autotransplants avec microsutures vasculaires, anatomie des zones donneuses. Ann Chir Plast 20: 163–170

    PubMed  Google Scholar 

  11. Dubreuil Chambardel L (1926) Traité des variations du système artériel, variations des artères du membre supérieur. Paris, Masson

    Google Scholar 

  12. Fisher J, Bostwick J, Powell RW (1983) Latissimus dorsi blood-supply after thoraco-dorsal vessel division: the serratus collateral. Plast Reconstr Surg 72: 502–509

    PubMed  Google Scholar 

  13. Fruchaud H, Boutin, Chaigneau G (1935) Remarques anatomochirurgicales sur le muscle grand dentelé. Ann Anat Pathol 12: 1031–1048

    Google Scholar 

  14. Gruber RP, Kahn RA, Lash H, Maser MR, Apfelberg DB, Laub DR (1981) Breast reconstruction following mastectomy: a comparison of submuscular and subcutaneous techniques. Plast Reconstr Surg 67: 312–317

    PubMed  Google Scholar 

  15. Hankins JR, Miller JE, Mac Laughlin JS (1978) The use of chest wall muscle flaps to close bronchopleural fistulas: experience with 21 patients. Ann Thorac Surg 25: 491–499

    PubMed  Google Scholar 

  16. Hankins JR, Miller JE, Attar S, Satterfield JR, Mac Laughlin JS (1978) Bronchopleural fistula: 13 years experience with 77 cases. J Thorac Cardiovasc Surg 76: 755–762

    PubMed  Google Scholar 

  17. Harii K, Ono I, Ebihara S (1982) Closure of total cheek defects with two combined myocutaneous free flaps. Arch Otolaryngol 108: 303

    PubMed  Google Scholar 

  18. Harii K, Yamada A, Ishihara K, Miki Y, Itoh M (1982) A free transfer of both latissimus dorsi and serratus anterior flaps with thoraco-dorsal vessel anastomoses. Plast Reconstr Surg 70: 620–627

    PubMed  Google Scholar 

  19. Hitzrot JM (1901) A composite study of the axillary artery in man. Johns Hopkins Hospital Bulletin, pp 136–145

  20. Jarrett JR, Cutler RG, Teal DF (1982) Aesthetic refinements in prophylactic subcutaneous mastectomy with submuscular reconstruction. Plast Reconstr Surg 69: 624

    PubMed  Google Scholar 

  21. Maier MC, Luomanen RKJ (1949) Pectoral myoplasty for closure of residual empyema cavity and bronchial fistula. Surgery 25: 621–624

    Google Scholar 

  22. Mathes SJ, Nahai F (1981) Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg 67: 177

    PubMed  Google Scholar 

  23. Mathes SJ, Nahai F (1982) Clinical applications for muscle and musculo-cutaneous flaps. Mosby, St Louis

    Google Scholar 

  24. Miller JI, Mansour KA, Nahai F, Jurkiewicz MJ, Harcher CR (1984) Single-stage complete muscle flap closure of the postpneumonectomy empyema space: a new method and possible solution to a disturbing complication. Ann Thorac Surg 38: 227–231

    PubMed  Google Scholar 

  25. Miller JI (1986) Muscle flaps: the management of post-resection empyema. 72nd Annual Clinical Congress. American College of Surgeons, October 19–24, 1986, New Orleans

    Google Scholar 

  26. Nguyen H, Nguyen HV (1986) Les 2 muscles clés des thoracotomies pour exérèses pulmonaires: le grand dorsal et la nappe serrato-rhomboïde. J Chir (Paris) 123: 626–634

    Google Scholar 

  27. Nguyen HV, Nguyen H (1987) Anatomical basis of modern thoracotomies, the latissimus dorsi and the serratus anteriorrhomboid complex. Surg Radiol Anat 9: 85–93

    PubMed  Google Scholar 

  28. Pairolero PC, Arnold PG, Piehler JM, Mac Goon DC (1983) Intrathoracic transposition of extrathoracic skeletal muscle. J Thorac Cardiovasc Surg 86: 809–817

    PubMed  Google Scholar 

  29. Pairolero PC, Arnold PG (1980) Bronchopleural fistula — Treatment by transposition of pectoralis major muscle. J Thorac Cardiovasc Surg 79: 142–145

    PubMed  Google Scholar 

  30. Pairolero PC, Arnold PG (1986) Thoracic wall defects: surgical management of 205 consecutive patients. Mayo Clin Proc 61: 557–563

    PubMed  Google Scholar 

  31. Rouvière H (1978) Anatomie Humaine III. Masson, Paris

    Google Scholar 

  32. Rowsell AR, Davies DM, Eisenberg N, Taylor GI (1984) The anatomy of the subscapular-thoraco-dorsal arterial system: study of 100 cadaver dissections. Br J Plast Surg 37: 574–576

    PubMed  Google Scholar 

  33. Rubinstein ZJ, Shafir R, Tsur H (1979) The value of angiography prior to use of the latissimus dorsi myocutaneous flap. Plast Reconstr Surg 63: 374–376

    PubMed  Google Scholar 

  34. Takayanagi S, Tsukie T (1982) Free serratus anterior muscle and myocutaneous flaps. Ann Plast Surg 8: 277–283

    PubMed  Google Scholar 

  35. Tarazona V, Paris F, Chamorro JJ, Baena P, Zarza AG, Mirabet V (1981) Comblement des poches résiduelles après pneumonectomie par transposition complète du grand dorsal du grand dentelé et du grand pectoral à propos de 4 malades. Ann Chir 35: 681

    Google Scholar 

  36. Taylor GI, Daniel RK (1975) The anatomy of several free flap donor sites. Plast Reconstr Surg 56: 243–253

    PubMed  Google Scholar 

  37. Testut L, Latarjet A (1948) Anatomie humaine-angéiologie, système nerveux central. Doin, Paris

    Google Scholar 

  38. Tobin GR, Schusterman M, Peterson GH, Nichols G, Bland KI (1981) The intramuscular neurovascular anatomy of the latissimus dorsi muscle: the basis for splitting the flap. Plast Reconstr Surg 67: 637–641

    PubMed  Google Scholar 

  39. Tobin GR, Mavroudis C, Howe WR, Gray LA (1983) Reconstruction of complex thoracic defects with myocutaneous and muscle flaps. J Thorac Cardiovasc Surg 85: 219–228

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Service de Chirurgie Thoracique et Vasculaire, Hôpital Beaujon, 100, boulevard du Général Leclerc, F-92118, Clichy, France

    P. Vu & B. Andreassian

  2. Service de Chirurgie Cervico-Faciale, Groupe Hospitalier Bichat-Claude Bernard, 46, rue Henri-Huchard, F-75018, Paris, France

    C. Guedon & P. Gehanno

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  1. P. Vu
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  2. C. Guedon
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  3. P. Gehanno
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  4. B. Andreassian
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Vu, P., Guedon, C., Gehanno, P. et al. Anatomic basis of serratus anterior muscle flap transposition. Surg Radiol Anat 10, 173–185 (1988). https://doi.org/10.1007/BF02115234

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  • DOI: https://doi.org/10.1007/BF02115234

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