(0624) Composite Latissimus Dorsi + Serratus Anterior/Rib Free Flap: Modern Use Cases and Literature Review

Introduction: Osseous defects of the head and neck with concomitant large soft tissue deficit are a reconstructive dilemma. A chimeric free flap including myogenous or myocutaneous latissimus dorsi and osteomyogenous serratus anterior/rib (LDSAR) is a pragmatic but rarely chosen reconstructive option. We present our multi-institutional series of 16 LDSARs and review the literature.

Methods: Cases from four surgeons (RB, SC, BC, PH) are retrospectively reviewed. Reconstructive rationale and indications are described. Flap planning, surgical anatomy, and defect-oriented inset strategies are presented photographically. Short and long-term outcomes are reported. Published literature is exhaustively reviewed and contextualized.

Results: In total, 16 LDSAR are presented. Reconstructed defects were mandible (7), calvarium (6), laryngotracheal complex (1), skull base (1), and rhinectomy (1). Outcomes were acceptable with 1 (6.3%) total flap loss and 1 partial flap loss (6.3%). A patient died as a result of fistula and infection. Minor complications included clinically insignificant pneumothorax (5), postoperative acute parotitis (1), and hematoma requiring washout (1). Review of the literature revealed 15 articles describing 112 LDSARs used for head and neck reconstruction. The combined flap failure rate in the literature was 0.9% total loss and 4.5% partial loss. Aggregate pneumothorax rate was 12.5%.

Conclusions: Composite LDSAR is an elegant solution for a complex problem. The volume and variety of tissue types provided by this flap allows the surgeon to nimbly reconstruct complicated and diverse extirpative defects. Our series adds to a sparse body of literature on this flap.