The scapular is more popularly known as the shoulder blade. The outside edge of the shoulder blade, along with its blood supply, can be used as a donor. The flap can also include combinations of skin and muscle and has low reported donor site problems for patients.

Blood vessels to this flap are usually of very good quality and spared from vessel changes seen in atherosclerosis (hardening of the vessels) seen elsewhere in the body. Also a good vessel length is usually possible, which means that the flap can be safely used for upper jaw and lower jaw reconstructions in most situations.

The main drawback to this flap was the fact that patients conventionally have had to be repositioned to have this performed which has considerably lengthened the operation.

Luke and Alastair, along with fellow reconstructive surgeons at Guys Hospital London have learned and evolved techniques to safely perform this surgery without the need to turn or reposition patients. This has greatly improved the utility of this type of reconstruction in head and neck surgery. The one drawback to this flap is that the bone is thinner than the fibular or DCIA, which means it’s not quite so good for implants.

Procedure

The scapular flap is performed under general anaesthetic, with the patient positioned lying down with the arm out to the side. A cut or incision is made along the sid,e running from below the armpit down around 10cms. The required amount of bone from the side of the scapular is taken along with any muscle that may be needed.

The blood vessels are then traced up in to the armpit or axilla, before being detached for transplantation to the upper or lower jaw. The cut is then carefully closed with a drain in the wound.

Risks

Infection

the surgical wound can get infected and this is usually treated adequately with a course of antibiotics.

Haematoma

This is a collection of blood in the surgical wound. To try to prevent this collecting normally at least one drain will be placed in to the wound. These usually stay for a few days after the operation.

Seroma

This is a collection of serous fluid in the wound and is usually treated fairly conservatively sometimes with repeated aspiration of the fluid. It settles eventually but sometimes this can take up to a few weeks. It normally doesn’t cause much in the way of symptoms for patients.

Shoulder dysfunction

Patients usually require physiotherapy input to improve shoulder function after surgery.