Free serratus anterior muscle transplantation for hand reconstruction.

Free transplantation of the serratus anterior muscle has allowed salvage or reconstruction of difficult hand injuries with advantages compared to traditional methods. Free muscle tissue adds vascularity to poorly vascularised and potentially infected wounds and allows hand elevation and early mobilisation. Dynamic reinnervation is possible with segmental preservation of the long thoracic nerve. The serratus anterior muscle is easily harvested and has a long, reliable vascular pedicle. It is thin, easily contoured to the defect and can be separated into its component slips. The muscle provides stable coverage when covered with a meshed split thickness skin graft. Scapular winging does not occur since only the lower two or three slips of muscle are used. The muscle has been used in 15 complex hand wounds, three within a week of revascularisation or digital replantation for hand salvage. Three dynamic muscle transfers were performed to restore thumb opposition with one simultaneous toe-to-thumb transplantation.