Scapular winging secondary to serratus anterior palsy was first described nearly three centuries ago. Since that time numerous procedures, dynamic and static in design, have been developed for the treatment of this clinical entity. Recent clinical studies demonstrate excellent results with the use of a split pectoralis major transfer to the inferior angle of the scapula. Autologous tendon grafts such as fascia lata or semitendinosus/gracilis may be used to augment the transfer. Successful direct transfer of the pectoralis major tendon, which may lower donor site morbidity associated with graft harvest, has been recently described. Overall, the literature reports satisfactory outcomes in 81percnt; to 100percnt; of patients treated with the pectoralis major transfer.
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