• P Perrot, C Kitsiou, S Yeo, V Lescour, and F Duteille.
• Service de chirurgie plastique et reconstructrice, centre des brûlés, CHU de Nantes, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France; Inserm, UMR 957, physiopathologie de la résorption osseuse et thérapie des tumeurs osseuses primitives, faculté de médecine, 1, rue Gaston-Veil, 44035 Nantes, France. Electronic address: pierre.perrot@chu-nantes.fr.
• Ann Chir Plast Esthet. 2016 Aug 1; 61 (4): 263-9.

IntroductionIn our team, free flap and especially serratus anterior muscle is the first option for the coverage of lower limb post-traumatic defects. For complex tissue loss, it may be advantageous to harvest the free serratus anterior with rib myo-osseous composite flap. We performed 20 osteomuscular serratus anterior composite flap between 2008 and 2010.Materials And MethodsWe retrospectively studied the records of 20 patients, by separately analyzing the characteristics of the bone defect and the soft tissue loss. Patients have been recently reviewed by an independent operator. We compared our results to other reconstruction techniques and other similar series reported in the literature.ResultsThe average age of our patients was 43 years and 11 months. In all cases, defect was traumatic. The average follow-up was 5 years (4.5 to 5.8). The average flap area was 135cm(2) and the average rib length was 9.21cm. Our microsurgical success rate is 95%. Our global consolidation rate is 82%.DiscussionUse of vascularized rib in the treatment of lower limb traumatic defects is rare. The bone quality of rib is lower than fibula, but the coverage provided is better, due to serratus anterior muscle. The length and diameter of the vascular pedicle is very useful too. Our results are comparable to other series using this flap. Its coverage properties and the possibility of simultaneous bone reconstruction is useful. It allows one stage procedure for complex tissue losses with satisfactory results in the short and long term. The further realization of a free fibular transfer in cases of persistent non union remains possible.Copyright © 2015 Elsevier Masson SAS. All rights reserved.

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