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The shoulder should be immobilized in an adducted position in the immediate postoperative period. This not only protects the muscle repairs to the scapula, but also protects the skin incision from tension. Seven to ten days postoperatively, the patient should begin gentle Codman exercises. Range-of-motion exercises should progress so that a secondary adhesive capsulitis does not develop. Permanent limitation of shoulder motion has not been reported.
Operative Sequence
PLATE XIII-1
 A. Operative position and surface markings of the osteocutaneous scapular flap. The preparation should include the entire upper extremity and start from posterior midline to anterior midline.
 B. The bilobed skin flap has been elevated. The vascular pedicle has been traced through the triangular space to the circumflex scapula vessels winding around the lateral border of the scapula to reach the subscapular origin. The lateral border of the scapula is exposed by elevating the origin of the teres major and minor from the lateral surface, and the subscapularis from the anterior surface, preserving the periosteum and its vascular supply from the descending and transverse branches of the circumflex scapular vessels.
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 C. The bone graft from the lateral border is being cut of transection of branches of the circumflex scapula to the posterior surface of the scapula.
 D. The bone has been mobilized up to the glenoid. The origin of the long head of the triceps must be detached to get maximum bone graft length.
PLATE XIII-2
 A. The compound flap has been separated and is viewed from its deep surface, showing the vascular supply from the thoracodorsal-circumflex scapular pedicle to the bone segment and skin segment.
B,
C.
Closure of the donor wound provides hemostasis and re-establishes muscle
integrity around the remaining scapula.
Clinical Studies
CASE 1
A 65-year-old man underwent resection of a left mandibular and floor-of-the-mouth tumor.
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