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Salunke AA, Nandy K, Kamani M, Parmar R, Bharwani N, Pathak S, Patel K, Pandya S. Is polypropylene mesh reconstruction functionally superior to non reconstructive group following total scapular resection? A retrospective analysis of 16 patients and a systematic review of the literature. J Orthop 2024; 52:37-48. [PMID: 38404696 PMCID: PMC10891286 DOI: 10.1016/j.jor.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
Background Various reconstruction methods have been described in medical literature on scapular tumor resection depending on the type of resection and other factors. However the ideal method of reconstructions has been still debatable. The purpose of the current study was to assess whether polypropylene mesh reconstruction is superior as compared to non reconstructive group following total scapular resection.We also evaluated how our method of reconstruction fare as compared to reported reconstruction methods in the published literature. Methods During 2014 to 2019; Total scapulectomy (Type III scapular resection) was performed in 16 patients for malignant tumor involving scapula bone. Reconstruction with polyprolene mesh(Group I) was performed in 56 % patient and non reconstruction technique (Group II) was observed in 44 % patient. The mean follow-up duration of current study was 28.3 months (range 13-67 months). The search method of PubMed and Cochrane databases provided 121 articles; of which 5 studies having 144 cases were utilised for final analysis. The reconstruction method used were dynamic humeral suspension (39.5%), non reconstruction method (35 %), scapular prosthesis (18 %) and static humeral suspension (5.5%). Results The mean Musculoskeletal tumor society score (MSTS) of the study cohort was 19.8(0-23); and that in polyprolene mesh or static suspension method (Group I) and non reconstructive technique (Group II) was 67 % and 61% respectively. The emotional acceptance score in group I was 4.5 and that in group II was 4.2 points. There was no difference in the shoulder movements in both the groups. The mean surgical durations in group I and group II was was 186 min and 140 min respectively. The systematic review showed the mean Musculoskeletal tumor society score (MSTS) of dynamic suspension and non reconstruction method were 63 % and 63.5% respectively. The mean Musculoskeletal tumor society score (MSTS) of scapula prosthesis tended to be higher than those with dynamic suspension (77 % vs 65 %). Conclusions The reconstruction with polypropylene mesh had better functional outcome and emotional acceptance as compared to non-reconstructive group in patients with total scapular resection surgery. The findings of systematic review suggest that; patients treated by reconstruction with polypropylene mesh and non-reconstructive group as compared to scapular prosthesis had limited shoulder movements with no difference in hand position, manual dexterity and lifting ability.
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Affiliation(s)
- Abhijeet Ashok Salunke
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Kunal Nandy
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Mayur Kamani
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Rahul Parmar
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Nandlal Bharwani
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | | | - Keval Patel
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
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May JM, Pathak A, Pientka WF, Meade AE, Duque S, Farewell JT, Zhang AY. Static and Dynamic Stabilization of the Shoulder After Total Scapulectomy in an Electric Burn Patient. Ann Plast Surg 2023; 90:S216-S220. [PMID: 36752401 DOI: 10.1097/sap.0000000000003392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
ABSTRACT An otherwise healthy 49-year-old man experienced a high-voltage electrical injury to the left shoulder resulting in total scapulectomy, partial calviculectomy, and a substantial soft tissue defect. The majority of the muscles around his shoulder were debrided because of necrosis, with only the pectoralis and latissimus dorsi muscles remaining attached to the humerus. Surprisingly, the patient's brachial plexus remained intact, and his left elbow, wrist, and hand function were preserved. A novel combination of 3 static and dynamic suspension techniques were used to stabilize his shoulder and prevent traction injury to the brachial plexus. Postoperative follow-up at 1 year demonstrated excellent stability of his reconstructed shoulder, which allowed him to ambulate independently and return to employment.
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Affiliation(s)
- Jessica M May
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Anna E Meade
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Sofia Duque
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Jordyn T Farewell
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Andrew Y Zhang
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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3
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Yu XJ, Liu QK, Wang YG, Wang SX, Lu R, Xu HR, Wan JL, Kang H. Oncologic and functional outcomes of different reconstruction modalities after resection of chondrosarcoma of the scapula: a medium- to long-term follow-up study. BMC Musculoskelet Disord 2022; 23:758. [PMID: 35941682 PMCID: PMC9358882 DOI: 10.1186/s12891-022-05661-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives To evaluate the oncologic and functional results of scapular reconstruction after partial or total scapulectomy for chondrosarcoma. Materials and methods Twenty-one patients with chondrosarcoma who underwent partial or total scapulectomy between January 2005 and July 2019 were reviewed retrospectively. Results At a mean follow-up of 62.6 months (range, 13–123 months), four patients developed local recurrence, and three developed distant metastases, one of which developed both recurrence and metastasis. The overall survival rate of patients at 5 years was 84.6%, the disease-free survival rate was 69.3%, and the complication rate was 19% (4/21). The 1993 American Musculoskeletal Tumor Society (MSTS93) scores of patients in the partial scapulectomy group, total scapulectomy + humeral suspension group and prosthetic reconstruction group were 26.50 ± 1.38, 19.00 ± 2.58, and 21.38 ± 2.62, respectively. There was a statistically significant difference between the partial scapulectomy group and the total scapulectomy + humeral suspension or prosthetic reconstruction group ( P = 0.006 and 0.0336, respectively). The range of motion of the shoulder joint for forward flexion was 80.83° ± 11.14°, 51.25° ± 21.36°, and 52.50° ± 11.02°, respectively. The p-values for the comparison between the partial scapulectomy group and the total scapulectomy + humeral suspension or prosthetic reconstruction group were 0.0493 and 0.0174, respectively. And the range of motion of abduction was 75.00° ± 10.49°, 32.50° ± 11.90°, 41.88° ± 11.63°, respectively. Patients in the partial scapulectomy group had significantly better postoperative shoulder abduction function than the total scapulectomy + humeral suspension or prosthetic reconstruction group (P = 0.0035 and 0.0304, respectively). There was no significant difference in MSTS93 scores and flexion and abduction function of the shoulder joint in the upper extremity after total scapulectomy with humeral suspension or prosthetic reconstruction (P > 0.05). Conclusions Surgical treatment of chondrosarcoma of the scapula can achieve a satisfactory prognosis and shoulder function. Total scapulectomy followed by prosthetic reconstruction or humeral suspension are both feasible treatments. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05661-7. Surgical treatment of chondrosarcoma of the scapula can achieve good oncologic and functional outcomes. Prosthetic reconstruction of the scapula after scapulectomy does not provide better functional results than humeral suspension, and both are feasible treatment modalities.
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Affiliation(s)
- Xiao-Jun Yu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyQiaokou DistrictHubei Province, No. 1095, Jiefang Avenue, 430030, Wuhan, China
| | - Qi-Kun Liu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyQiaokou DistrictHubei Province, No. 1095, Jiefang Avenue, 430030, Wuhan, China
| | - Ying-Guang Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyQiaokou DistrictHubei Province, No. 1095, Jiefang Avenue, 430030, Wuhan, China
| | - Shan-Xi Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyQiaokou DistrictHubei Province, No. 1095, Jiefang Avenue, 430030, Wuhan, China
| | - Rui Lu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyQiaokou DistrictHubei Province, No. 1095, Jiefang Avenue, 430030, Wuhan, China
| | - Hao-Ran Xu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyQiaokou DistrictHubei Province, No. 1095, Jiefang Avenue, 430030, Wuhan, China
| | - Jun-Lai Wan
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyQiaokou DistrictHubei Province, No. 1095, Jiefang Avenue, 430030, Wuhan, China
| | - Hao Kang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyQiaokou DistrictHubei Province, No. 1095, Jiefang Avenue, 430030, Wuhan, China.
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Li J, Bi J, Zhao X, Yao P, Liu Y, Bi W. [Evaluation of total scapular arthroplasty after total scapulectomy for scapular tumors]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:179-183. [PMID: 32030948 DOI: 10.7507/1002-1892.201907016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the effectiveness of total scapular arthroplasty after total scapulectomy for scapular tumors. Methods A clinical data of 17 patients with scapular tumors treated with total scapulectomy and total scapular arthroplasty between January 2010 and December 2017 were retrospectively reviewed. There were 9 males and 8 females with an average age of 34.4 years (range, 13-64 years). Seven patients were diagnosed with chondrosarcoma, 3 with osteosarcoma, 2 with Ewing's sarcoma, 1 with high-grade sarcoma, 1 with polymorphic dedifferentiated sarcoma, 1 with fibrosarcoma, 1 with plasmacytoma, and 1 with bone giant cell tumor. According to the surgical staging system described by Enneking et al, 1 patient was rated as stage 3, 8 as stageⅠB, 8 as stageⅡB. According to the classifications of shoulder girdle resections of Malawer et al, 11 patients were type ⅢB, 5 were type ⅣB, 1 was type ⅥB. The disease duration ranged from 0.5 to 8.0 months (mean, 3.2 months) and tumor size ranged from 11.0 cm×7.5 cm×6.0 cm to 18.5 cm×18.0 cm×12.5 cm. The 1993 Musculoskeletal Tumor Society (MSTS) upper limb function scoring system and shoulder mobility were used to evaluate postoperative shoulder joint function. Tumor recurrence and metastases were monitored by radiograph. Results Poor superficial incision healing occurred in 1 patient, the rest incisions achieved healing by first intention. All patients were followed up 20-72 months (mean, 45.4 months). Two of the 17 patients died of multiple organ dysfunction syndrome caused by tumor metastases; 3 patients suffered from pulmonary metastases and were alive with disease. No local recurrence occurred in all patients. The overall survival rate was 88.2% (15/17) and the disease-free survival rate was 70.6% (12/17). Rib fracture after trauma, aseptic loosening, and atrophy of the deltoid muscle occurred in 1, 1, and 1 case, respectively. The other related complication was not observed. At last follow-up, the MSTS score was 26.1±1.4, and the flexion, extension, and abduction range of motion of shoulder joint were (70.0±7.5), (31.2±11.3), and (54.4 ±12.5) °, respectively. Conclusion Reconstruction with total scapular arthroplasty after total scapulectomy can obtain a satisfactory shoulder contour and an acceptable functional outcomes in patients with scapular tumors.
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Affiliation(s)
- Jianxiong Li
- Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Jingyou Bi
- Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Xuelin Zhao
- Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Peng Yao
- Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China;Xinxiang Detachment of Henan General Corps of Chinese People's Armed Police, Xinxiang Henan, 453000, P.R.China
| | - Yatao Liu
- Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Wenzhi Bi
- Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
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Araki Y, Yoshida A, Tanzawa Y, Endo M, Kobayashi E, Kawai A. Reconstruction of the Shoulder Joint with a Custom-Made Ceramic Implant After a Total Scapulectomy: A Case Report. JBJS Case Connect 2019; 8:e12. [PMID: 29489523 DOI: 10.2106/jbjs.cc.17.00061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We describe a 22-year-old woman who underwent total scapulectomy and shoulder joint reconstruction with use of a custom-made ceramic implant composed of hydroxyapatite and beta-tricalcium phosphate (β-TCP) for a recurrent atypical perineurioma that had arisen from the scapula. CONCLUSION To our knowledge, there have been no previous reports of shoulder joint reconstruction with use of a custom-made ceramic implant after a total scapulectomy. The patient showed excellent function of the new shoulder joint and good range of motion without pain or dislocation at 18 months postsurgery. This new method of reconstructing the shoulder joint after a total scapulectomy appears useful and promising.
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Affiliation(s)
- Yoshihiro Araki
- Divisions of Musculoskeletal Oncology (Y.A., Y.T., M.E., E.K., and A.K.) and Pathology and Clinical Laboratories (A.Y.), National Cancer Center Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Akihiko Yoshida
- Divisions of Musculoskeletal Oncology (Y.A., Y.T., M.E., E.K., and A.K.) and Pathology and Clinical Laboratories (A.Y.), National Cancer Center Hospital, Tokyo, Japan
| | - Yoshikazu Tanzawa
- Divisions of Musculoskeletal Oncology (Y.A., Y.T., M.E., E.K., and A.K.) and Pathology and Clinical Laboratories (A.Y.), National Cancer Center Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Makoto Endo
- Divisions of Musculoskeletal Oncology (Y.A., Y.T., M.E., E.K., and A.K.) and Pathology and Clinical Laboratories (A.Y.), National Cancer Center Hospital, Tokyo, Japan
| | - Eisuke Kobayashi
- Divisions of Musculoskeletal Oncology (Y.A., Y.T., M.E., E.K., and A.K.) and Pathology and Clinical Laboratories (A.Y.), National Cancer Center Hospital, Tokyo, Japan
| | - Akira Kawai
- Divisions of Musculoskeletal Oncology (Y.A., Y.T., M.E., E.K., and A.K.) and Pathology and Clinical Laboratories (A.Y.), National Cancer Center Hospital, Tokyo, Japan
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Mimata Y, Nishida J, Nagai T, Tada H, Sato K, Doita M. Importance of latissimus dorsi muscle preservation for shoulder function after scapulectomy. J Shoulder Elbow Surg 2018; 27:510-514. [PMID: 29269139 DOI: 10.1016/j.jse.2017.09.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/15/2017] [Accepted: 09/20/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Scapulectomy is an inevitable treatment for sarcomas of the scapula. This procedure is unavoidable because it reduces the local recurrence rate but can impair shoulder movements and affect the activities of daily living. This study investigated the factors influencing functional outcomes after scapulectomy. MATERIALS AND METHODS The clinical results of 8 patients (5 males, 3 females) who were diagnosed with primary or metastatic sarcomas of the scapula were retrospectively reviewed. The mean age was 49 years (range, 11-86 years). We examined the correlation between the type of excision of the scapula (total, subtotal, or partial) and postoperative functional outcomes according to the Musculoskeletal Tumor Society (MSTS) score. In partial excision, the glenohumeral joint was preserved; in subtotal excision, the glenoid was completely resected and some bony components were preserved; and in total excision, the entire bony component of the scapula was resected. The average follow-up period was 55 months (range, 9-142 months). RESULTS The partial, subtotal, and total excision groups had mean functional scores of 96.7%, 76.7%, and 62.2%, respectively. Although the mean functional scores were lower in patients who underwent total and subtotal excisions, 3 patients in whom the latissimus dorsi muscle was preserved had better function (mean MSTS score, 76.7%) than the 2 patients in whom it was not preserved (mean MSTS score, 55.0%). CONCLUSION These results suggest that the latissimus dorsi muscle, along with the deltoid and pectoralis major muscles, is one of the stabilizers of the proximal humerus after scapulectomy.
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Affiliation(s)
- Yoshikuni Mimata
- Department of Orthopaedic Surgery, Iwate Medical University, School of Medicine, Morioka, Japan.
| | - Jun Nishida
- Department of Orthopedic Surgery, Tokyo Medical University, School of Medicine, Tokyo, Japan
| | - Taro Nagai
- Department of Orthopedic Surgery, Tokyo Medical University, School of Medicine, Tokyo, Japan
| | - Hiroshi Tada
- Department of Orthopaedic Surgery, Iwate Medical University, School of Medicine, Morioka, Japan
| | - Kotaro Sato
- Department of Orthopaedic Surgery, Iwate Medical University, School of Medicine, Morioka, Japan
| | - Minoru Doita
- Department of Orthopaedic Surgery, Iwate Medical University, School of Medicine, Morioka, Japan
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Angelini A, Mavrogenis AF, Trovarelli G, Pala E, Arbelaez P, Casanova J, Berizzi A, Ruggieri P. Extra-articular shoulder resections: outcomes of 54 patients. J Shoulder Elbow Surg 2017; 26:e337-e345. [PMID: 28689824 DOI: 10.1016/j.jse.2017.04.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 04/21/2017] [Accepted: 04/26/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The survival of patients with tumors around the shoulder treated with extra-articular resection, the rates of reconstructions-related complications, and the function of the shoulder cannot be estimated because of limited available data from mainly small published related series and case reports. METHODS We studied 54 patients with tumors around the shoulder treated with extra-articular shoulder resections and proximal humeral megaprosthetic reconstructions from 1985 to 2012. Mean tumor volume was 549 cm3, and the mean length of the proximal humeral resection was 110 mm. Mean follow-up was 7.8 years (range, 3-21 years). We evaluated the outcomes (survival, metastases, recurrences, and function) and the survival and complications of the reconstruction. RESULTS Survival of patients with malignant tumors was 47%, 38%, and 35%, at 5, 10, and 20 years, respectively. Rates for metastasis and local recurrence were 60% and 18.5%, respectively. Survival was significantly higher for patients without metastases at diagnosis, tumor volume <549 cm3, and type IV resections. Survival of reconstructions was 56% at 10 years and 48% 20 years. Overall, 19 patients (35.2%) experienced 30 complications (55.5%), the most common being soft tissue failures that required subsequent surgery without, however, implant removal. The mean Musculoskeletal Tumour Society score was 25 points, without any significant difference between the types of extra-articular resections. CONCLUSION Tumor stage and volume as well as type of resection are important predictors of survival of patients with malignant tumors around the shoulder. Survival of the reconstructions is satisfactory; nevertheless, the complication rate is high. The Musculoskeletal Tumour Society score is similar with respect to the type of resection.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, Padova, Italy
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Giulia Trovarelli
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, Padova, Italy
| | - Elisa Pala
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, Padova, Italy
| | - Pablo Arbelaez
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, Padova, Italy
| | - Josè Casanova
- Department of Orthopaedics, University of Coimbra, Coimbra, Portugal
| | - Antonio Berizzi
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, Padova, Italy
| | - Pietro Ruggieri
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, Padova, Italy.
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8
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Xu SF, Yu XC, Xu M, Hu YC, Liu XP. Functional Results and Emotional Acceptance after Scapulectomy for Malignant Shoulder Tumors. Orthop Surg 2017; 8:186-95. [PMID: 27384727 DOI: 10.1111/os.12248] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/07/2016] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To demonstrate the functional results and emotional acceptance after scapulectomy for various malignant shoulder tumors. METHODS Eight patients with malignant shoulder tumors who had undergone scapulectomy between April 2004 and March 2014 were retrospectively reviewed. They comprised seven men and one woman their mean age was 54 years (range, 24-69 years). All patients were diagnosed by pathological examination of biopsy specimens. The tumors were metastatic in four cases, having originated from a primary carcinoma of the liver in one patient, the lung in one patient and the kidney in two patients. The other four patients had primary malignant tumors in their scapulae, specifically, two scapular malignant fibrous histiocytomas, one scapular Ewing sarcoma and one soft tissue synovial sarcoma. The four patients with metastases were staged as III, and other four were staged as IIB. Six patients underwent total and two subtotal scapulectomy. The remaining soft tissues were sutured together directly in seven of the patients. The remaining patient, who had soft tissue synovial sarcoma, required transfer of a pedicle latissimus dorsi muscle flap. The functional results and emotional acceptance were evaluated by clinician using the Musculoskeletal Tumor Society (MSTS) scoring system. RESULTS The average duration of follow-up was 22.8 months. Four patients were continuously disease-free, three patients developed metastases and died of disease within 12 months of surgery and one patient with a scapular metastasis from the kidney survived with pulmonary nodules. No major complications, including infection or dislocation, occurred during or after surgery. The mean MSTS score was 16.3 (54%), which is similar to that previously reported in other studies of scapulectomy. There were no local tumor recurrences and only one patient developed pulmonary metastases. These outcomes are similar to those reported for scapular prostheses and there were fewer complications than in patients treated with allografts. The mean emotional acceptance score was 3.6 (72.5%). CONCLUSIONS Performing scapulectomies on patients with malignant shoulder tumors without prostheses or allograft reconstruction achieves good functional results and emotional acceptance with a low rate of complications.
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Affiliation(s)
- Song-Feng Xu
- Department of Orthopaedics, General Hospital of Jinan Military Region, Jinan, China
| | - Xiu-Chun Yu
- Department of Orthopaedics, General Hospital of Jinan Military Region, Jinan, China
| | - Ming Xu
- Department of Orthopaedics, General Hospital of Jinan Military Region, Jinan, China
| | - Yong-Cheng Hu
- Department of Orthopaedic Oncology, Tianjin Hospital, Tianjin Medical University, Tianjin, China
| | - Xiao-Ping Liu
- Department of Orthopaedics, General Hospital of Jinan Military Region, Jinan, China
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9
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Capanna R, Totti F, Van der Geest ICM, Müller DA. Scapular allograft reconstruction after total scapulectomy: surgical technique and functional results. J Shoulder Elbow Surg 2015; 24:e203-11. [PMID: 25842026 DOI: 10.1016/j.jse.2015.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 02/07/2015] [Accepted: 02/16/2015] [Indexed: 02/08/2023]
Abstract
HYPOTHESIS Scapular allograft reconstruction after total scapulectomy preserving the rotator cuff muscles is an oncologically safe procedure and results in good functional outcome with a low complication rate. METHODS The data of 6 patients who underwent scapular allograft reconstruction after a total scapulectomy for tumor resection were retrospectively reviewed. At least 1 of the rotator cuff muscles was preserved and the size-matched scapular allograft fixed to the residual host acromion with a plate and screws. The periscapular muscles and the residual joint capsule were sutured to the corresponding insertions of the allograft. RESULTS The mean follow-up was 5.5 years (range, 24-175 months). In all patients, a wide surgical margin was achieved. The average functional scores were 20 points for the International Society of Limb Salvage score and 60 points for the American Shoulder and Elbow Surgeons score. Mean active shoulder flexion of 60° (range, 30°-90°) and mean active abduction of 62° (range, 30°-90°) were achieved. During the follow-up, 1 patient (16.6%) had a local recurrence and lung metastasis, whereas the remaining 5 patients (83.3%) were disease free. Two breakages of the osteosynthesis and 2 allograft fractures were observed, necessitating a revision surgery in 2 cases (33.3%). In this series, no infection, allograft resorption, or shoulder instability occurred. CONCLUSION Allograft substitution of a completely removed scapula is an oncologically safe procedure, with good functional results, avoiding common complications in prosthetic replacements such as infection and dislocation of the shoulder joint.
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Affiliation(s)
- Rodolfo Capanna
- Department of Orthopedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesca Totti
- Department of Orthopedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ingrid C M Van der Geest
- Department of Orthopedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Daniel A Müller
- Department of Orthopedic Surgery, University Hospital Balgrist, Zurich, Switzerland.
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Hoornenborg D, Veltman ES, Oldenburger F, Bramer JAM, Schaap GR. A patient with scapular Ewing sarcoma; 5-year follow-up after extracorporeal irradiation and re-implantation of the scapula, a case report. J Bone Oncol 2013; 2:30-2. [PMID: 26909269 PMCID: PMC4723359 DOI: 10.1016/j.jbo.2012.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 12/13/2012] [Accepted: 12/17/2012] [Indexed: 12/16/2022] Open
Abstract
In 2007 a 9½-year-old boy was treated with resection, extracorporeal irradiation and re-implantation of the right scapula. He also received chemotherapy. During five year follow-up shoulder function remained largely intact. Subtotal resorption of the scapula occurred, leaving only the glenohumeral joint intact. Sensibility and strength are intact. To date there is no sign of local or metastatic recurrence.
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Affiliation(s)
- Daniel Hoornenborg
- Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands
| | - Ewout S Veltman
- Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands
| | - Foppe Oldenburger
- Department of Radiotherapy, Academic Medical Center Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands
| | - Jos A M Bramer
- Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands
| | - Gerard R Schaap
- Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands
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11
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Functional outcomes after total scapulectomy for malignant bone or soft tissue tumors in the shoulder girdle. Int J Clin Oncol 2011; 16:568-73. [DOI: 10.1007/s10147-011-0229-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 03/17/2011] [Indexed: 11/26/2022]
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12
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Mavrogenis AF, Mastorakos DP, Triantafyllopoulos G, Sakellariou VI, Galanis EC, Papagelopoulos PJ. Total scapulectomy and constrained reverse total shoulder reconstruction for a Ewing's sarcoma. J Surg Oncol 2009; 100:611-5. [PMID: 19582796 DOI: 10.1002/jso.21340] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Total scapulectomy and intra-articular resection of the glenohumeral joint indicates the Malawer Type III shoulder girdle resection. MATERIALS AND METHODS The modified Tikhoff-Linberg total scapulectomy and constrained reverse total shoulder reconstruction for a Ewing's sarcoma of the scapula is presented. A combined approach has been used. The deltoid, trapezius, rhomboids, levator scapulae, latissimus dorsi, and serratus anterior were preserved. the tumor was removed en bloc by disarticulation of the acromioclavicular and the glenohumeral joints. The scapular prosthesis was suspended by the muscles. A constrained reverse humeral prosthesis was implanted after osteotomy of the humeral head. RESULTS There were no intraoperative or postoperative complications; surgical margins were clear. At 12 months postoperatively, the patient has a stable and painless shoulder. CONCLUSION The goal of shoulder reconstructions is to provide a stable and painless joint that allows positioning of the arm and hand in space. Compared to those patients left without a scapula reconstruction, prosthetic replacement of the scapula and shoulder partially restores abduction and external rotation and improves cosmesis.
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Affiliation(s)
- Andreas F Mavrogenis
- First Department of Orthopaedics, ATTIKON University Hospital, Athens Medical School, Athens Greece
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13
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Chandrasekar CR, Mohammed R, Grimer RJ. Extracorporeally irradiated scapula as autograft in tumor surgery. J Shoulder Elbow Surg 2008; 18:e28-32. [PMID: 19095466 DOI: 10.1016/j.jse.2008.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 05/28/2008] [Accepted: 07/24/2008] [Indexed: 02/01/2023]
Affiliation(s)
- Coonoor R Chandrasekar
- Musculoskeletal Oncology Unit, the Royal Orthopaedic Hospital NHS Trust, Birmingham, United Kingdom.
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14
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Pritsch T, Bickels J, Wu CC, Squires MH, Malawer MM. Is scapular endoprosthesis functionally superior to humeral suspension? Clin Orthop Relat Res 2007; 456:188-95. [PMID: 17006374 DOI: 10.1097/01.blo.0000238840.26423.b6] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Humeral suspension was the most popular reconstructive procedure after total scapulectomy until the early 1990s. Since 1992 the senior author has been performing scapular endoprosthetic reconstruction after total scapulectomy whenever the rhomboids, latissimus dorsi, deltoid, and trapezius were preserved. We hypothesized that scapular endoprosthetic reconstruction resulted in better functional and cosmetic results than humeral suspension. From 1979 to 2003, 32 consecutive patients had total scapulectomies. Reconstructions included humeral suspensions in 16 patients and scapular endoprostheses in 16 patients. Functional and cosmetic results were compared retrospectively between the two groups. Patients with scapular endoprostheses had better functional results and superior cosmesis as compared with patients with humeral suspension. The mean Musculoskeletal Tumor Society scores for patients with scapular endoprostheses and humeral suspensions were 78.5% and 58.5% respectively. Seven patients with scapular endoprostheses had greater than 40 degrees abduction and 11 patients with humeral suspensions could not abduct the shoulder greater than 20 degrees. Twelve patients with humeral suspensions and none with scapular endoprostheses wore shoulder pads or customized orthoses for cosmetic purposes. After total scapulectomy, scapular endoprosthetic reconstruction led to better functional and cosmetic results than humeral suspension and therefore we recommend performing this reconstructive procedure whenever the rhomboids, latissimus dorsi, deltoid, and trapezius are preserved.
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Affiliation(s)
- Tamir Pritsch
- Department of Orthopaedic Oncology, Washington Cancer Institute, Washington, DC 20010, USA.
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15
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Wuisman P, Witlox A, van Diest P, Manoliu R. Growing mass in the right suprascapular region. Clin Orthop Relat Res 2004:321-7. [PMID: 15057116 DOI: 10.1097/00003086-200403000-00046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Paul Wuisman
- Department of Orthopaedic Surgery, Vrije Universiteit Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
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