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 FIG. 21-27. A single slip of serratus was isolated on its vascular pedicle to match the facial defect. The case demonstrates another advantage of the versatile serratus flap.
 FIG. 21-28.The long vascular pedicle permits repair to the superficial temporal vessels. Muscle next to defect.
 FIG. 21-29. The 8 cm pedicle has been tunneled to the superficial temporal vessels.
 FIG. 21-30. Late follow-up with restoration of contour. Frontal view.
 FIG. 21-31. Lateral view.
CASE 6
A man sustained a shotgun blast to the forearm.
 FIG. 21-32. Emergent revascularization of the hand, temporarily restored with arterial shunts during complex bony stabilization.
 FIG. 21-33. The preoperative x ray documents the extensive injury.
 FIG. 21-34. Following serial debridements and external fixation, the wound is ready for closure.
 FIG. 21-35. A serratus MVT was placed over the wound and anastomosed to the side of the ulnar artery, then covered with a meshed skin graft.
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 FIG. 21-36. Closed healed wound.
CASE 7
A man had a degloving injury of the left hand from a motor vehicle accident.
 FIG. 21-37. There are multiple metacarpal fractures and exposed tendons.
 FIG. 21-38. Two slips of serratus have been selected to cover the tendons and provide vascular closure. Recipient vessels were the radial artery end-to-side.
 FIG. 21-39. The flap in place. Laser Doppler and muscle pH probes have been placed into the flap for postoperative monitoring.
 FIG. 21-40. The flap is covered with skin grafts.
 FIG. 21-41. Complete closure, good contour, and full extension.
 FIG. 21-42. Flexion.
CASE 8
A chronically infected wrist wound has been resistant to reconstructive efforts with a previous groin flap and tissue expansion.
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