Serratus anterior free-tissue transfer: Harvest-related morbidity in 34 consecutive cases and a review of the literature

Donor-site morbidity in serratus anterior free-tissue transfers is investigated in 34 consecutive cases. Nineteen lower-extremity reconstructions and 15 facial reconstructions were retrospectively analyzed. Office and hospital charts were reviewed, and patients were given a follow-up questionnaire. The mean operative time was 6.3 hr and the mean estimated blood loss was 441 cc. Transfusion was required in 24 percent of cases. The early complication rate was 21 percent consisting of 6 percent hematomas and 15 percent seromas. Scar appearance, pain, numbness, and shoulder strength and mobility were acceptable. Scapular winging was detectable in 3/9 patients examined, but symptomatic in only one. The number of muscle slips harvested or whether the graft was innervated did not significantly affect this rate. Half of the patients had returned to work or school. None attributed any work disability to their donor sites. They participated in many athletic activities, including those requiring upper extremity strength and dexterity. Previously reported series are discussed, and the morbidity of this donor site is compared with reported series of other free muscle flaps. The authors find this flap useful for facial reanimation and for soft-tissue coverage with minimal bulk. Low rates of operative, perioperative, and long-term morbidity are definite advantages.