The serratus anterior osteocutaneous free flap.

Microvascular transfer of the rib as an osteocutaneous or osseous free flap based on the thoracic branch of the thoracodorsal artery is described. A review of the literature revealed various patterns of rib vascularization in different areas of the body from the periosteum and the endosteal vessels. Reversing the blood flow in the transcortical vessels of the rib is reported to be possible. Injection studies showed a reliable connection between the thoracic branch of the thoracodorsal artery and the endosteal vessels of the sixth and seventh ribs at the origin of the anterior serratus muscle. This approach to free rib transfer has proved to be quick, easy, and reliable in various clinical applications.