Maxfacts

Back

Postoperative problems affecting the back include

• Scars. The major reasons for postoperative problems on the back in maxillofacial patients are the harvesting of flaps for reconstructive purposes to repair soft and/or hard tissue defects. The two donor sites are
  
  
  • the latissimus dorsi muscle (the large, flat muscle to the side of the back and running from the mid to the lower back), used for free (where the transferred tissue is completely detached from the donor site) or pedicled (where the transferred tissue remains partially connected with the donor site) flaps;
  • any variation of the scapula (shoulder blade) free flap.
  Both these donor sites can be closed primarily. The latissimus dorsi and parascapular (vertically orientated) version of the scapula skin flap are vertically running scars on the back that are rarely infected and heal well. The horizontally designed scapula skin flap has a scar which tends to spread and is generally less aesthetic.
• Shoulder function. This can be quite seriously interfered with by harvesting the bone of the lateral border (on the side) of the scapula. This bone is less useful for most jaw reconstruction purposes than the fibula (the smaller of the two long bones in the lower leg) or iliac crest (part of the hip) bones but is very rarely involved in peripheral vascular disease (which may limit the choice of harvest locations in some patients). A small number of centres use the scapula flap predominantly and it is worthwhile considering the alternatives, particularly if the scapula flap is taken from the same side as the neck dissection on the side of the dominant arm (dictated by the site of the cancer or other pathology being removed). Limitation of function of the arm and shoulder and associated pain, especially if on the dominant side, cannot be underestimated.
• Altered sensation is rarely noticed as a problem.