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

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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.

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