Surface acoustic wave (SAW) based microfluidic devices provide active techniques to manipulate fluid and particles, which can be used for precise and controllable patterning of microparticles and biological cells, with a high efficiency in a non-invasive and contact-free manner. This paper investigates flexible and bendable SAW microfluidic devices and explores the effects of bending and twisting of SAW devices on microparticle and cell patterning, using both experimental and numerical modelling. We showed that bending flexible SAW devices changes the distribution of particle pattern lines significantly. In devices with concave bending the particle pattern lines converge towards the centre of the curvature, whereas for devices with convex bending, they diverge away from it. Comparing the particle patterning using Lamb and Rayleigh wave devices with concave bending, we found that particle alignment is more efficient in the flexural mode Lamb wave device, whereas for the devices with convex bending, the particle patterning is more clear and regular when Rayleigh waves are used. We further investigated the effects of twisting the flexible SAW devices and observed that the particles are patterned into lines parallel to the deformed interdigital transducers (IDTs). We finally patterned yeast cells using our flexible SAW devices, and demonstrated the possibility of using our flexible acoustofluidic device for biomechanical systems such as body conforming technologies, wearable bio-sensors, and flexible point-of-care devices for personalized health monitoring.