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.
About the author
Wendy Ketner, M.D.
Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.
Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.
Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.
