Prefabricated Expanded Skin Flap With the Serratus Branch of the Thoracodorsal Artery for Extensive Facial Resurfacing

Background: Extensive postburn facial scarring cannot achieve aesthetic resurfacing with skin graft or mismatched flaps. Although adjacent flap donor sites, such as the neck or deltopectoral area, provide ideal skin characteristics, flap transfer may be highly limited due to the absence of proper axial vessels. Here, we demonstrate an innovative reconstructive alternative in terms of prefabrication and tissue expansion for extensive facial resurfacing. Methods: A serratus anterior fascia flap within the serratus branch of the thoracodorsal artery was harvested and microsurgically transferred as the pedicle of a prefabricated cervicothoracic flap. The flap, with the fascia located in a subcutaneous pocket over a tissue expander, was raised, islanded, and rotated to reconstruct the facial defect after reliable expansion and maturation. Flap size, donor/recipient site, surgical outcomes, and donor-site morbidity were all evaluated. Results: The flap sizes ranged from 13 × 10 to 27 × 21 cm. All 15 patients with extensive postburn facial scars, aged 15–40 years (mean 30.73 y), achieved successful reconstruction without major complications after 6–12 months of follow-up. Conclusions: The prefabricated, expanded cervicothoracic flap with the serratus branch of the thoracodorsal artery demonstrated a favorable color and texture match with the recipient site. The donor site can be primarily closed with minimized aesthetic and functional compromise.