What is Scapular Free Flap Procedure

Scapular free flap procedure is surgery to remove healthy tissue from the shoulder area so it can be used to replace diseased or damaged tissue elsewhere in the body (reconstruction). The scapula, commonly called the shoulder blade, is a bone that is located in the shoulder.

During this procedure, a piece of tissue and some of the blood vessels that supply the tissue are taken from the shoulder area (donor site). This scapular free flap is then transplanted to another part of the body by surgically attaching (grafting) it. The transplant may be done during the same procedure or at a later time.

This surgery can be done to replace damaged tissue in various areas of the body. It is often used to treat people with head and neck cancer who have had part of the jaw removed.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.
• Whether you smoke or use tobacco products. These can interfere with anesthesia and slow the healing process.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Blood clots.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Shoulder weakness, stiffness, or both.
• Long-lasting (chronic) pain.
• Limited arm movement, or a decreased range of motion.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given an antibiotic medicine to help prevent infection.

General instructions

• Plan to have someone take you home from the hospital.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be asked to shower with a germ-killing soap.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• You may have imaging tests done, such as an ultrasound, CT scan, or MRI.
• You may have blood or urine samples taken.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
• A tube (catheter) may be placed in your bladder to drain urine.
• You may be placed on your side or your abdomen for the procedure.
• An incision will be made over your scapula where you were marked before the procedure.
• Your skin and the other tissues will be carefully removed from the scapula (donor site).
• Your blood vessels in the area will be closed (cauterized) to stop bleeding.
• Your incision will be closed with stitches (sutures), staples, tape, glue, or a combination of these.
• If your graft is done at the same time as your scapular free flap procedure:
  • You may be re-positioned.
  • The donor-site tissue will be attached to the site being repaired (recipient site). The tissue and blood vessels from the donor site will be reattached to tissue and blood vessels at the recipient site.
  • The scapular flap will be attached to the recipient site using sutures, staples, tape, glue, or a combination of these.
• A small tube (drain) may be placed in the area to drain blood and fluid from the wound.
• A bandage (dressing) will be placed over the donor site and recipient site.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• Your catheter will be removed after you are awake and able to pass urine on your own.
• You will be given pain medicine through your IV tube or by mouth.
• You may also be given antibiotics.
• You may have IV tubes inserted to provide medicines and nutrients while you are in the hospital.
• You will need to stay in the hospital. Ask your health care provider how long you will stay.
• You may have to wear compression stockings or sleeves. These help prevent blood clots and reduce swelling in your legs and arms.
• Do not drive for 24 hours if you were given a sedative.

Summary

• A scapular free flap procedure is surgery to remove healthy tissue from the shoulder area so it can be used to replace diseased or damaged tissue elsewhere in the body.
• Follow instructions from your health care provider about eating and drinking before the procedure.
• You will need to stay in the hospital after the procedure. Ask your health care provider how long you will stay.
• Plan to have someone take you home from the hospital.

Scapular Free Flap Procedure, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Swelling, bruising, and pain in the shoulder area where the tissue was removed (donor site).
• Swelling, bruising, and pain at the site where the diseased or damaged tissue was removed and replaced (recipient site).
• Limited use of your arm and shoulder on the side of the procedure. Your health care provider may recommend physical therapy to help you regain movement (mobility) in your arm and shoulder.
• Sleepiness from the medicines that you were given during the procedure.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Follow instructions from your health care provider on how to care for surgical drains. Drains may be in place for 3–5 days after the procedure.
• Check your incision areas every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

• Do not lift anything that is heavier than 10 lb (4.5 kg) until your health care provider says that it is safe.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• If physical therapy was prescribed, do exercises as told by your health care provider.

Driving

• Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during your procedure.
• Do not drive or use heavy machinery while taking prescription pain medicine.

General instructions

• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider when it is okay for you to shower.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can affect healing. If you need help quitting, ask your health care provider.
• Wear compression garments as told by your health care provider. Compression garments help to prevent blood clots and reduce swelling.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You have more redness, swelling, or pain around your incisions.
• You have fluid or blood coming from your incisions.
• Your incisions feel warm to the touch.
• You have pus or a bad smell coming from your incisions.
• You cannot eat or drink without vomiting.

Get help right away if:

• You have trouble breathing.
• You have chest pain or an irregular heartbeat.
• You are confused or have trouble speaking.

Summary

• After the procedure, it is common to have swelling, bruising, and pain in the area where tissue was removed (donor site) and at the site where the diseased or damaged tissue was removed and replaced (recipient site).
• After the procedure, you may have limited use of your arm and shoulder on the side of the procedure.
• You may need physical therapy to help increase your arm and shoulder movement.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes, because using these products can affect healing.