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Microsurgery. 2013 Mar;33(3):173-83. doi: 10.1002/micr.22067. Epub 2013 Feb 25.

The treatment of composite defect of bone and soft tissues with a combined latissimus dorsi and serratus anterior and rib free flap.

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Department of Plastic and Reconstructive Surgery, China Medical University Hospital, 2 Yuh-Der Road, Taichung 40447, Republic of China, Taiwan.



Composite defects of bone and soft tissues represent a reconstructive challenge. Several techniques have been described in the medical literature; however, extensive composite defects should be reconstructed with microvascular free tissue transfer. The purpose of this report is to present the use of a composite latissimus dorsi and serratus anterior and rib free flap (LD-SA/rib) as an alternative procedure in patients who cannot undergo more commonly used vascularized bone-containing free flap reconstruction.


Since January 2009, 12 patients have undergone bone and soft tissues reconstruction with a composite LD-SA/rib flap. In this case series, indications for LD-SA/rib reconstruction were large mandibular defects after oral cancer ablation, scalp defects, and lower extremity defects.


All flaps survived entirely. With reference to postoperative complications, haematoma occurred in four patients, scar contractures in three cases, lower lip incontinence in one patient, and local infection in one patient. Skin graft revision was performed in two cases and secondary debulking procedure in three patients. Flap viability was consistent during the 2-year follow-up.


LD-SA/rib free flap should be regarded as an effective procedure for reconstruction of composite tissue defects in patients who are not candidates for more commonly used vascularized bone-containing free flaps.

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