What is a Scapula free flap?

A scapula free flap is one way of filling a bony hole in either the upper or lower jaw. It

is one of the common ways of replacing bone that has been removed or damaged.

What does the surgery involve?

• Your surgeon will take a piece of bone from your shoulder blade (scapula bone).

• Part of the scapula bone and overlying skin, most of the time, (the flap) is removed along with two blood vessels, one of which supplies blood to the flap (the artery) and one of which drains blood from it (the vein).

• Once the necessary piece of bone from the shoulder blade is removed it is transferred to the head and neck and secured in position with small plates and screws.

• The blood vessels supplying and draining the flap are then joined to blood vessels in your neck under a microscope. These blood vessels then keep theflap alive while it heals into its new place.

What happens to the ‘hole’ in the shoulder blade?

The hole in the scapula bone that is left after the flap is removed is left to heal on its

own. Ittakes several months for the shoulder blade to heal completely but at the end

of this time it will be as strong as it was before the surgery.

What can I expect after the operation?

The area of your shoulder where the bone has been removed is likely to be sore.

Regular painkillers will be arranged for you. A small tube is also placed through the

skin into the underlying wound to drain any blood that may collect. This ‘drain’ is

usually removed after a few days.

Will I have a scar?

All cuts made through the skin leave a scar but the majority of these fade with time.

The scar on the back of your shoulder blade is usually several inches long.

What are the possible problems?

There are potential complications with any operation. Fortunately with this type of

surgery complications are rare and may not happen to you. However it is important

that you are aware of them and have the opportunity to discuss them with your

surgeon.

• Bleeding – since a ‘drain’ is inserted into your shoulder wound, bleeding is

unusual.

• Infection – you will be given antibiotics through a vein whilst you are asleep

during surgery and in the early period after surgery. Surgical site infections

occur in approximately 1: 5 patients as a general rule

• Numbness – occasionally a patch of skin over the back of your shoulder will

feel numb and tingly after the operation. This numbness may take several

months to disappear and in a minority of patients may last forever.

• Shoulder movement–You may find that your shoulder movements are

restricted after surgery but this is often due to swelling, the position of any

drains and the clips in your skin. Gentle exercise will also help to reduce any

swelling in the area, and help prevent shoulder and neck pain and stiffness.

• Flap failure – in two – five percent of cases one of the blood vessels

supplying or draining the flap can develop a blood clot within it. This means

that the flap doesn’t get any fresh blood or, if the drainage vein clots, then the

flap becomes very congested with old blood. If this occurs it usually happens

within the first two days and means that you will have to return to the

operating theatre to have the clot removed. Removing the clot is not always

successful and on these occasions the flap ‘fails’ and an alternative method of

reconstruction sought.

• What exercises should I be doing? Most patients benefit from simple

exercises. Following a scapula free-flap it important to keep your shoulder and

shoulder girdle moving. Your Physiotherapists will encourage you to start

exercises.