Free serratus anterior artery perforator flap: a case report with an anatomic and radiological study

Perforator flaps have become very popular in reconstructive surgery. The thoracodorsal and lateral tho-racic artery perforator flaps are highly studied, and suc-cessful clinical series have been reported, whereas the literature concerning the lateral intercostal and serratus anterior artery perforator flaps is quite poor and their vas-cular anatomy needs yet to be clarified. We describe a case of free serratus anterior artery perforator flap for the recon-struction of a dorsal defect of the foot, followed by an ana-tomic and radiological study. A 17-year-old boy reported a fracture of the first and second metatarsal bone of the left foot, with a dorsal skin defect, due to a motorcycle acci-dent. After the osteosynthesis treatment, a perforator was identified through a handheld Doppler in the lateral chest area and a cutaneous paddle was designed. Retrograde dis-section revealed the perforator’s direct link to the serratus anterior pedicle. In our knowledge, an elucidated method to preoperatively visualize the perforating vessel of the ser-ratus anterior artery has not yet been described. Thus, an anatomic study on 8 hemithorax and a radiological study on 33 computed tomographic angiographies of the chest were carried out to clarify the vascular anatomy of the serratus anterior artery perforators and to verify the pos-sibility of their preoperative visualization. The authors believe that the serratus anterior artery perforator could be preoperatively investigated, thus making this flap a valu-able option when harvesting a perforator flap in the lateral chest area.