Background: The fibula is the most commonly used flap for reconstruction of segmental mandibular defects. In a subset of patients the presence of peripheral vascular disease (PVD) can compromise adequate three-vessel run-off preventing its safe harvest. In this group of patients where a reconstruction is required the composite serratus anterior/rib (SAR) free flap can be a viable and functional alternative.

Methods: A retrospective medical chart review assessing indications, peri-operative complications and long-term outcomes of reconstruction.

Results: Eight patients with 9 SAR flaps were reviewed. In 63% of patients the indication was PVD. 1 patient suffered a partial rib necrosis, but the muscle survived. Placement of a chest tube was not required in any case. Minimum follow-up was 6 months. Good contour was obtained in all patients.

Conclusion: Composite SAR free flap is a good reconstructive option for patients with PVD. Advantages include: its long vascular pedicle, large calibre vessels rarely affected by PVD, adequate length of bone with cartilage available, primary closure of donor site with minimal post-operative functional morbidity, intra-operative utilization of a two-team approach. The main disadvantage is the lack of dense cortical bone making implant rehabilitation unlikely.

Key words: serratus anterior; rib; head neck reconstruction

Disclosure: None.