Three-dimensional shoulder kinematics after total claviculectomy: a biomechanical investigation of a single case

Clinical Applications and Outcomes of the Supraclavicular Osteocutaneous Flap for Head and Neck Reconstruction

OBJECTIVE

This study evaluates the clinical applications of the supraclavicular osteocutaneous (SOC) flap in complex head and neck reconstruction and its impact on shoulder function following clavicle resection.

STUDY DESIGN

Case series with a planned chart review.

SETTING

Single-institution tertiary care center.

METHODS

We reviewed patients with complex mandibular and maxillary defects who underwent SOC flap reconstruction from 2016 to 2020. We detailed flap harvesting techniques, patient characteristics, diagnoses, defect sites, bone dimensions, skin paddle size, vascular supply, and donor site management. Complications and outcomes were also documented.

RESULTS

The study included 7 patients with diverse clinical conditions and diagnoses. Reconstruction techniques varied, leading to different clavicle thicknesses and skin paddle sizes. Two cases had flap necrosis due to infection, and 1 experienced chronic shoulder discomfort following partial-thickness clavicle flap surgery. Full-thickness clavicle harvesting resulted in better outcomes and simplified the procedure. Notably, there were no significant long-term complications affecting shoulder function.

CONCLUSION

The SOC flap is a promising option for complex head and neck reconstruction, adaptable to specific case requirements and providing reliable vascular supply. It offers favorable clinical outcomes both functionally and aesthetically. Full-thickness clavicle harvesting, with joint preservation, effectively maintains shoulder function.

Vascularized Reconstruction of Recalcitrant Clavicular Nonunion with the Medial Femoral Condyle Free Flap: A Systematic Review of the Literature

Recalcitrant clavicular nonunion is an uncommon but challenging problem. Vascularized bone reconstruction is not first-line therapy due to complexity and donor morbidity, though it has utility in select cases. A systematic review of Embase and Medline databases was undertaken for cases of medial femoral condyle reconstruction for clavicle nonunion. Ten studies met inclusion, encompassing 26 patients. Mean age was 38.9 years. Ten patients were male and 16 female. Mean time of nonunion was 37.79 months prior to intervention; mean time to union following medial femoral condyle flap was 7.60 months. Two patients did not achieve union. Of the 11 patients who previously had at least one failed fixation with bone graft, considered the current "gold standard", 9 patients (81.81%) went on to achieve union, while 2 patients (18.19%) did not. There were six reported complications in five patients. Medial femoral condyle flap is a valuable option in recalcitrant clavicle nonunion.

Total clavicle reconstruction with free peroneal graft for the surgical management of chronic nonbacterial osteomyelitis of the clavicle: a case report

BACKGROUND

Chronic nonbacterial osteomyelitis (CNO) is a rare chronic autoinflammatory syndrome affecting mainly children and young adults. The natural history of the disease is marked by recurrent pain as the mainstay of inflammatory outbreaks. Typical radiographic findings are osteosclerosis and hyperostosis of the medial clavicle, sternum and first rib. Compression of the brachial plexus is exceedingly rare and one of the few surgical indications. Literature on total clavicle reconstruction is scarce. While claviclectomy alone has been associated with fair functional and cosmetic outcomes, several reconstruction techniques with autograft, allograft or even cement ("Oklahoma prosthesis") have been reported with the aim of achieving better pain control, cosmetic outcome and protecting the brachial plexus and subclavian vessels. We herewith report a unique case of complicated CNO of the clavicle treated with total clavicle reconstruction using a free peroneal graft.

CASE PRESENTATION

A 21-year-old female patient presented with CNO of her left clavicle, associated with recurrent, progressive and debilitating pain as well as limited range of motion. In recent years, she started complaining of paresthesia, weakness and pain radiating to her left arm during arm abduction. The clavicle diameter reached 6 cm on computed tomography, with direct compression of the brachial plexus and subclavian vessels. Following surgical biopsy for diagnosis confirmation, she further developed a chronic cutaneous fistula. Therefore, a two-stage total clavicle reconstruction using a vascularized peroneal graft stabilized by ligamentous reconstruction was performed. At two-year follow-up, complete pain relief and improvement of her left shoulder Constant-Murley score were observed, along with satisfactory cosmetic outcome.

CONCLUSIONS

This case illustrates a rarely described complication of CNO with direct compression of the brachial plexus and subclavian vessels, and chronic cutaneous fistula. To our knowledge, there is no consensus regarding the optimal management of this rare condition in this context. Advantages and complications of clavicle reconstruction should be carefully discussed with patients due to limited evidence of superior clinical outcome and potential local and donor-site complications. While in our case the outcomes met the patient's satisfaction, it remains an isolated case and further reports are awaited to help surgeons and patients in their decision process.

Is clavicular reconstruction imperative for total and subtotal claviculectomy? A systematic review

BACKGROUND

The effects of clavicular reconstruction on total and subtotal claviculectomy are controversial. The aim of this study is to disclose the impact of clavicular reconstruction on the efficacy of this rare surgical procedure.

METHODS

This is a systematic review of multiple medical databases for level I through IV evidence.

RESULTS

Eleven studies (level IV) with a mean follow-up duration of 53 months (range, 12-156 months) met the inclusion criteria. There were 70 subjects (70 shoulders) including 36 male patients (51%), and the average age at operation was 30 years (range, 2-77 years). The etiology included tumors in 34 subjects (49%) and other disorders in 36 (51%). Of the patients, 41 (59%) underwent total claviculectomy whereas 29 (41%) underwent subtotal clavicular excision. Clavicular reconstruction was performed in 14 subjects (20%), with bone allograft in 8, autograft in 1, and a bone cement prosthesis in 5. Objective measurement disclosed compromised strength and mobility in aclaviculate limbs; however, no studies investigating clavicular reconstruction used similar means of measurement. Functional assessment scales implied global limb function following the 2 procedures was similar (American Shoulder and Elbow Surgeons score, P = .13; Constant score, P = .38). Claviculectomy with and without reconstruction resulted in a similar incidence of complications (P = .45); however, isolated claviculectomy was related to fewer further surgical procedures (P <.001) and faster recovery (P <.001). The 2 procedures were associated with similar satisfaction rates (P > .99).

CONCLUSIONS

No evidence suggested clavicular reconstruction led to clinical outcomes superior to those of isolated claviculectomy. It is noteworthy that isolated excision of the clavicle was associated with a lower risk of further surgery and faster rehabilitation.

The significance of the clavicle on shoulder girdle function

BACKGROUND

Patients with cleidocranial dysplasia (CCD) can have a congenital partial or total absence of the clavicle. The aim of this study was to evaluate the functional shoulder score in these patients.

MATERIAL AND METHODS

Patients with CCD who were members of a social media group were invited to take part in an Internet-based survey. The questionnaire was composed of 3 general questions, a question concerning partial or total absence of the clavicle, and 3 patient-based shoulder scores (American Shoulder and Elbow Surgeons score; shortened Disabilities of the Arm, Shoulder, and Hand score; and patient-based Constant-Murley score).

RESULTS

Thirty-six patients (27 women, 9 men) with a mean age of 40 years participated in the survey; 17 patients had a bilateral absence, 16 patients had a bilateral partial absence, and 3 patients had a total absence on one side and a partial absence of the clavicle on the other side. The average patient-based Constant-Murley score was 79; shortened Disabilities of the Arm, Shoulder, and Hand score, 11; and American Shoulder and Elbow Surgeons score, 93. There was no significant difference in the scores between left and right. There was no correlation between partial and total absences and the shoulder scores.

CONCLUSION

Patients with self-reported CCD are subjectively normal to their peers when they are evaluated with 3 common shoulder scores. There was no correlation between partial and total absences and the shoulder scores.