Serratus Anterior Venous Tributary as a Second Outflow Vein in Latissimus Dorsi Free Flaps

ABSTRACT

The latissimus dorsi (LD) flap is a large and reliable myocutaneous flap with a consistently long vascular pedicle. However, the limitation of the thoracodorsal pedicle is that it has only one draining vein for anastomosis. We describe a simple technique of recruiting the tributary vein to the serratus anterior and using it as a second draining vein to alleviate congestion in lower limb reconstruction. The serratus anterior venous tributary segment is cut back to an avalvular segment which averages 5 mm in length. Provision of an additional venous outflow to the flap enabled a second venous anastomosis to the short saphenous vein (n = 1), the long saphenous vein (n = 2), a deep vein (n = 1), and to a deep vein via a vein graft (n = 1), respectively. Five patients with degloving injury of the lower extremity of sizes 150 cm² (10 × 15 cm) to 260 cm² (10 × 26 cm) underwent successful reconstruction using the LD muscle flap with the serratus anterior tributary vein as a second outflow vein. This serratus anterior venous tributary serves as a useful second outflow channel for alleviating venous congestion during lower limb reconstructive surgery and should be routinely preserved as a lifeboat.

Latissimus dorsi - serratus anterior vein - venous congestion

REFERENCES

• 1 Bayramiçli M, Tetik C, Sönmez A, Gürünlüoğlu R, Baltaci F. Reliability of primary vein grafts in lower extremity free tissue transfers.  Ann Plast Surg. 2002;  48 (1) 21-29
• 2 Culliford IV A T, Spector J, Blank A, Karp N S, Kasabian A, Levine J P. The fate of lower extremities with failed free flaps: a single institution's experience over 25 years.  Ann Plast Surg. 2007;  59 (1) 18-21 discussion 21-22
• 3 Godina M. Preferential use of end-to-side arterial anastomoses in free flap transfers.  Plast Reconstr Surg. 1979;  64 (5) 673-682
• 4 Rainer C, Schwabegger A H, Bauer T et al.. Free flap reconstruction of the foot.  Ann Plast Surg. 1999;  42 (6) 595-606 discussion 606-607