Incorporation of the Vascularized Serratus Fascia Flap during Latissimus Dorsi Flap Harvest to Minimize Morbidity after Axillary Clearance

Abstract

Breast cancer-related axillary node dissection is the commonest cause of upper extremity lymphedema. The ability of lymphatics to regenerate spontaneously or reconnect with native lymphatics after free or pedicled flap reconstruction has been demonstrated on lymphoscintigraphy. Lymphatic anastomosis is not always needed in these flaps. In patients who underwent axillary clearance with risk factors for the development of lymphedema, we harvested a vascularized serratus anterior fascia flap during concurrent latissimus dorsi flap harvest (for breast or chest wall reconstruction). The vascularized fascia was wrapped around the axillary vessels to provide a conduit for lymphatic regeneration, protect the axillary vessels from radiotherapy, and reduce scarring and axillary cording. This procedure was performed on three patients with none of them experiencing upper limb lymphedema or cording.