Experience of total scapular excision for musculoskeletal tumor and reconstruction in eastern Asian countries

Static and Dynamic Stabilization of the Shoulder After Total Scapulectomy in an Electric Burn Patient

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.

Scapular Osteosarcoma Treated by Scapulectomy with or Without Scapular Allograft: A Retrospective Case Series

Background

Osteosarcoma of the scapula is extremely rare. Hence, there is no consensus regarding its optimal management. In this study, we report the demographics, characteristic features, and outcomes of scapulectomy with or without scapular allograft reconstruction in a series of patients with primary scapular osteosarcoma.

Materials and Methods

Twelve patients with primary scapular osteosarcoma who were treated by scapulectomy with or without scapular allograft reconstruction (five and seven patients, respectively) were included. The allograft was fixed in place using a dacron tape without a plate or screw. The function of the shoulder was evaluated using the Musculoskeletal Tumor Society (MSTS) score for the upper extremity and Toronto Extremity Salvage Score (TESS).

Results

The study population included seven (58.3%) males and five (41.7%) females with a mean age of 30 ± 8.2 years. The histologic type of the tumor was osteoblastic in the majority of patients (n = 8, 66.7%). At an average follow-up of 6.5 ± 2.3 years, only one local recurrence (8.3%) occurred in our patients that coincided with lung metastasis. The mean MSTS score was 78.7 ± 3.8% and 66.2 ± 4% in patients with and without scapular allograft, respectively (P = 0.006).‏ The mean TESS was 78.6 ± 5.6 and 68.4 ± 2.4 in patients with and without scapular allograft, respectively (P = 0.005).‏ The overall 5-year survival of the patients was 85.7%.

Conclusion

‏ Osteosarcoma of scapula more frequently occurs in the fourth decade of life, mainly presented with a sclerotic radiologic appearance. Patients with scapular allograft impaction after scapulectomy have better functional outcomes compared to those without boney reconstruction.

Oncologic and functional outcomes of different reconstruction modalities after resection of chondrosarcoma of the scapula: a medium- to long-term follow-up study

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.

Endoprosthetic Reconstruction of the Upper Extremity in Oncologic Surgery

In 1943, Austin Moore successfully reconstructed a proximal femur using a Vitallium endoprosthesis. This marked the first successful alternative to amputation in oncologic surgery. However, it was not until the introduction of high-resolution axial imaging and improved chemotherapeutics that the feasibility of limb salvage began to improve. Today, limb salvage surgery can be used to treat most oncologic conditions of the extremities, the most popular reconstruction option being endoprostheses. Megaprostheses use has expanded to nononcologic indications with severe bone loss, including infections, revision arthroplasty, and severe periarticular trauma and its sequelae. The proximal humerus and scapula are challenging for reconstruction, given the complex anatomy of the brachial plexus, the accompanying vascular structures, and the dynamic stabilizers of the relatively nonstable glenohumeral joint. The midhumerus is difficult because of the close location of the radial nerve, whereas the distal humerus is challenging because of the proximity of the brachial artery and its bifurcation, radial, ulnar, and median nerves, and lack of soft-tissue coverage. Despite these challenges, this review demonstrates that many series show excellent mid- to long-term results for pain relief and function restoration after megaprosthetic reconstruction of the scapula and humerus after bone resections for oncologic and nononcologic reasons.

[Complication management following resection and reconstruction of the upper limbs and shoulder girdle]

BACKGROUND

Sarcomas of the upper limbs commonly affect the proximal humerus or scapula. Complications after tumor resection and reconstruction are rare but cannot be neglected, particularly after tumor endoprosthetic reconstructions.

MATERIALS AND METHODS

The most common complications after resection of sarcomas of the upper limbs and shoulder girdle are described, and current knowledge regarding complication management is presented. Additionally, a selective literature search was performed, incorporating personal experiences.

RESULTS

Wound healing disorders and infections after tumor resection without specific reconstruction (clavicle resection, scapulectomy) usually respond well to conservative or surgical treatment. However, periprosthetic infections after reconstruction using a megaendoprosthesis constitute a severe and frequent complication, with an incidence of 5-10%. Two-stage implant replacement still represents the gold standard, although in selected cases, one-stage revision with retention of the prosthetic stem appears warranted. Secondary amputation as a result of periprosthetic infection is rare compared to the situation with infections of the lower limb. Mechanical complications necessitating surgical revision are mostly limited to joint dislocation after inverse total shoulder replacement (TSR). (Sub)luxation in anatomic TSR can be tolerated provided there is no tendency toward perforation of the skin in a asymptomatic patient. Biological reconstructions are most often indicated for reconstruction of intercalary defects of the humerus, and revision is necessitated most frequently by mechanical complications. Despite multiple surgical revisions, stable reconstructions and limb salvage can usually be achieved in the upper limb.