Split Pectoralis Major Transfer for Serratus Anterior Palsy

Serratus anterior palsy, with the resulting scapular winging, can be a functionally devastating and painful injury to the shoulder girdle. We describe our preferred technique of directly transferring the sternal head of the pectoralis major to the inferior angle of the scapula through 2 limited incisions. This reduces the possibility of graft stretching, preventing the recurrence of winging, and accomplishes satisfactory cosmesis. Only in cases in which muscle length is inadequate despite sufficient mobilization do we use a graft. We have used the Graft Jacket (Wright Medical Technology, Arlington, TN) to supplement and augment the muscle transfer.