Faculty Collaboration Database

Detailed neurovascular anatomy of the serratus anterior muscle: implications for a functional muscle flap with multiple independent force vectors. Plast Reconstr Surg 2004 Jul;114(1):21-9; discussion 30-1

Date

06/29/2004

Pubmed ID

15220562

DOI

10.1097/01.prs.0000129072.11466.c3

Scopus ID

2-s2.0-4444345145 (requires institutional sign-in at Scopus site)   34 Citations

Abstract

A functional muscle free flap with multiple muscle segments that could be oriented independently to produce different force vectors would be beneficial in facial reanimation and upper extremity reconstruction. The serratus anterior muscle has this potential because two or more individual muscle slips can be transferred on a single vascular pedicle. Although serratus anterior muscular anatomy has been studied previously, little attention has been given to the intramuscular anatomy. Muscle slips 5 through 9 (and 10, if present) in 50 specimens from 27 cadavers were studied following intraarterial latex injection. Eight specimens were injected with a radiopaque material (latex/diatrizoate/lead mixture) for x-ray delineation of the intramuscular vascular pattern. Slips 5 through 9 are consistently supplied by a single dominant branch of the thoracodorsal artery and innervated by the long thoracic nerve. Dissection revealed that the long thoracic nerve and its branches invariably follow the artery and divide proximal to the corresponding arterial division. There is a consistent vascular pattern to each muscle slip, in which the serratus artery gives rise to common slip arteries, each of which supplies adjacent muscle slips. The mean length of a muscle slip from its origin on the rib periosteum to the division of the common slip artery is 9.6 cm. These findings imply that the slips may be separated to the level of these common slip arteries, with up to five slips transferred on a single neurovascular pedicle and each slip oriented independently to provide multiple muscle force vectors. With these possibilities, the reconstructive surgeon may be able to restore more natural facial animation and better intrinsic muscle function in the upper extremity.

Author List

Godat DM, Sanger JR, Lifchez SD, Recinos RF, Yan JG, Godat MR, Ramirez CE, Matloub HS

Authors

Hani S. Matloub MD Emeritus Professor in the Plastic Surgery department at Medical College of Wisconsin
James R. Sanger MD Professor in the Plastic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Biomechanical Phenomena
Face
Hand
Humans
Middle Aged
Muscle, Skeletal
Ribs
Surgical Flaps