The serratus anterior/rib composite flap in mandibular reconstruction.

A flap comprising the serratus anterior muscle and the underlying rib, based on the serratus branches of the thoracodorsal artery has been developed. In addition to the rib the potential exists to include a cartilaginous growth centre, a functional muscle and/or overlying skin. A latissimus dorsi musculocutaneous unit can be included on a common pedicle. This paper describes its use as both a free and a pedicled composite unit in mandibular reconstruction. The surgical anatomy of the flap is reviewed and cases are shown to illustrate its use in the treatment of congenital, malignant and post-traumatic conditions where reconstruction of the lower jaw is required.