Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 21:
Free Serratus Anterior Static and Dynamic Muscle Transplantation
  FIG. 21-57. A serratus flap consisting of a single muscle segment and the underlying eighth rib has been harvested to provide a vascularized bone graft.

FIG. 21-58. X ray of the rib in position, maintaining thumb length.

FIG. 21-59. Follow-up with maintenance of thumb length. There is a painless pseudarthrosis at the IP and basilar joints, providing some motion. The patient is working.


A 16-year-old girl caught her hand in a meat grinder while working after school. The ulnar half of the hand has been severely damaged with multiple metacarpal fractures. None of the fingers were replantable because of the multilevel nature of the injury.

FIG. 21-60. Dorsal view.

FIG. 21-61. Palmar view.

FIG. 21-62. X ray shows midshaft metacarpal fractures reduced with intramedullary and interosseous wires.

FIG. 21-63. Wound closure with the serratus MVT flap was performed at 48 hours after injury, providing volar and dorsal vascularized cover.


FIG. 21-64. The flap has been tailored to allow fitting with an esthetic prosthesis.


A patient had chronic osteomyelitis of the distal tibia following a motor vehicle accident.

FIG. 21-66. Tibial wound.

FIG. 21-67. Osteomyelitic defect with retained screw on x ray.

FIG. 21-68. The wound was widely debrided on two occasions, then closed with serratus MVT.

FIG. 21-69. Early result.

FIG. 21-70. Two-year follow-up without recurrence. The patient has returned to horseback riding. This approach has revolutionized the management of chronic bone infections.


A diabetic patient had a chronic infected calcaneal wound that did not heal after multiple previous grafting procedures.

FIG. 21-71. Appearance of wound.

next page...

  2002 © This page, and all contents, are Copyright by The Buncke Clinic