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Donor Site Morbidity After Serratus Anterior Free Muscular Flap: A Prospective Clinical Study

This study was designed to assess donor site morbidity after using the serratus anterior muscle as a free vascularized flap. The 3 distal slips of the serratus anterior were harvested from 3 dominant and 4 nondominant shoulders of 7 consecutive patients (age range, 36–61 years) to treat chronic osteitis or infected nonunions of the lower limb. Both donor and recipient sites healed primarily in all patients. Six of the 7 patients were enrolled in a postoperative shoulder-strengthening program. Preoperative and 3-month follow-up Constant scores and peak torque values of the operated shoulders were compared using the Wilcoxon matched pairs signed rank test. The pre- and postoperative Constant score were 95% and 93% respectively. Peak shoulder torque for abduction, adduction, flexion, and extension was assessed at both 60°/second and 120°/second. No statistical differences were found between the pre- and postoperative values. At the final follow-up (mean, 17 months), clinical examination revealed no scapular winging in all patients. Six patients answered a self-administered questionnaire to assess function of the shoulder. The average score in the pain domain was 36.3 points (with 40 points meaning free of pain). The average score in the activities of daily living domain was 18.5 of 20 points. The overall satisfaction rate with the donor site was very good in 2 patients and good in 4 patients. In conclusion, removal of the 3 distal slips of the serratus anterior for use as a free vascularized transfer did not impair shoulder function in this group of patients.