Fig. 3.

Management of failed transradial TMR using a free serratus muscle flap to provide additional muscle targets for revision TMR without sacrificing remaining critical muscles. A, Intraoperative photograph demonstrating the neurovascular pedicle to the serratus muscle, two distal slips of which were used as recipients at revision targeted muscle reinnervation in case 1. B, A fasciocutaneous thoracodorsal artery perforator flap was harvested along with the serratus muscle as a chimeric flap for soft-tissue reconstruction at the antecubital fossa. The median and ulnar nerve neuromas are shown in relation to the serratus muscle. C, Final flap inset and closure.