Patient Loses Arm Function Following Allegedly Botched Bone Graft

Case Overview

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.

Questions to the Plastic Surgery expert and their responses

How often do you perform scapular tip free flap surgery?

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).

What steps in the procedure are taken to prevent the type of complication seen here?

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.

About the expert

This highly qualified and Board Certified expert has obtained his BS from Indiana University and his Medical Degree from Washington University School of Medicine. He completed a residency in Plastic Surgery at University of Michigan and a fellowship in Microvascular Reconstruction at the University of Pennsylvania. He also has a masters degree in clinical outcomes research and ten years of experience researching peri-operative deep venous thrombosis and pulmonary embolus in surgical patients. He is a member of multiple prestigious professional societies including the American Society of Plastic Surgeons, American College of Surgeons, American Society for Reconstructive Microsurgery, American Venous Forum and the American College of Chest Physicians. He has 71 peer-reviewed research articles; the majority of which examine DVT and PE prevention among surgical patients. He also has 13 book chapters. Currently, he is an Assistant Professor in the Division of Plastic Surgery at a top-tier University medical center in Utah.