Free serratus anterior fascia flap for reconstruction of hand and finger defects

Reconstruction of the dorsal surface of hand defects requires thin, pliable, well vascularized tissue with a gliding surface for the extensor tendon course. Also defects of the palmar hand and degloved fingers need non-bulky soft tissue for reconstruction. We present a retrospective analysis of nine patients with free serratus anterior fascia flaps used to cover defects of the palmar and dorsal hand and of degloved fingers. Three of the patients presented limited range of hand motion due to full-thickness burns; one patient had defects of the dorsum of one hand after acute burn injury. Two patients had an acute trauma of the dorsum of the hand with extensor tendon injury, another patient a soft-tissue defect of his thumb and dorsal hand due to an avulsion injury. One patient presented dorsal defect of three fingers after degloving injury. One patient had a palmar defect after industrial crush injury with exposed tendons, vessels, and nerves. The flaps were applied as pure fascial flaps with an immediate partial-thickness skin graft. One patient presented a partial necrosis of < 10% flap size. All other flaps survived completely. Two of the patients presented wound healing problems of the skin graft that healed secondarily. All patients recovered useful hand function without a bulky contour of their hand or fingers. Except for the scar, no donor-site morbidity was reported. The free serratus anterior fascia flap has good functional and cosmetic properties and there is low donor-site morbidity. It is an excellent flap for soft-tissue reconstruction combined with extensor tendon reconstruction on the dorsum of the hand. The flap is also very useful for palmar and finger defects.