This case involves a 57-year-old male patient in Missouri who underwent a surgical procedure for treatment of his advanced-stage cancer. The procedure involved a bone graft and ultimately resulted in mobility complications for the patient. The patient lost total function in his left arm and suffered severe pain due to excessive scarring and contractures from the surgery. As a result, the patient’s shoulder required significant physical therapy and occupational therapy. It was alleged that the treating plastic surgeon botched the bone graft causing the patient to lose function in his arm.
Question(s) For Expert Witness
- 1. How often do you perform scapular tip free flap surgery?
- 2. What steps in the procedure are taken to prevent the type of complication seen here?
Expert Witness Response E-067040
I am a board-certified plastic surgeon and a fellowship trained reconstructive microsurgeon. I have an active university-based reconstructive microsurgery practice, and I regularly perform parascapular free flaps (the source flap on which the scapular tip flap is based). In the process of including the scapular tip with the parascapular flap, the insertion of the serratus muscle can be divided or stripped off. If the serratus muscle is no longer attached to the scapula, then the scapula could “wing.” A long, thoracic nerve injury would be another potential cause of scapular winging. It would certainly depend on the case itself. Physical therapy afterwards is very important and the degree of PT/OT is important. I have reviewed a similar case of microsurgical head and neck reconstruction.