Upper Extremity Reconstructions

Limb salvage procedures in primary bone tumours of the scapula offer attractive prospects regarding function and aesthetics. What procedure depends mainly on the site/extension, stage/diagnosis. In scapular resections the glenoid plays the key role. This retrospective study shows single centre Results regarding outcome. Methods: From October 1983–February 1998 thirty-three patients presenting with primary malignant bone and soft tissue tumours of the scapula were treated in LUMC. Tumour type: chondrosarcoma (17), Ewing (7), MFH (5), osteosarcoma, leiomyosarcoma, rhabdomyosarcoma, synoviosarcoma either one. Patient gender (male 17, female 16). The mean age 35.4 (10–69 y). Mean followup 9 years (4–18 years). Results: Four patients had only chemotherapy and radiation therapy (Ewing 3, MFH 1). In 30 patients the procedures performed were resection (28) and fore quarter (2). The scapula resection consisted in corpus (16), total scapula (6), acromion (3) and glenoid (3). Reconstruction was performed by allograft [ total scapula (2), radius/glenoid (2)] or prosthesis (total scapula (3), glenoid (1) and Tikhoff-Linberg (1). Oncological outcome: recurrence 5 [chondrosarcoma (4), rabdomyosarcoma (1)] . Treatment recurrence resection (3), forequarter (1). Disease free survivors 22; tumour related death 6 [4 Stage IIIB, Ewing (2), MFH, rhabdomyosarcoma] alive with disease 4 [chondrosarcoma (4)] , death unrelated to tumour 1 [chondrosarcoma]. Complications reconstruction: No complications in partial resections of the scapular body (soft tissue reconstruction). Both total scapula allografts had complications: resorption and fracture (1), undisplaced fracture (1). Radius/glenoid reconstruction: resorption (1). Prosthesis: no complications [except traumatic humeral fracture(1)] . No infections/luxation. All shoulders were stable including the allograft with resorption. 4 of 7 Ewing (all had chemotherapy + radiotherapy) survived. 3 out of 4 survivors of the Ewing were treated by resection (one total 2 partial). If the glenoid was preserved functional Results are overall good. All patients had stable shoulder functions. The more scapula (spina scapula) and muscle remained the better function. Acromion resection resulted in normal function in all. Glenoid reconstruction (allograft, prosthesis) resulted in stable but restricted shoulder, good elbow hand function in all. In all patients the cosmetic appearance was good or excellent. Conclusion: Resection of part/total scapula might result in a stable often good shoulder function especially if the glenoid can be preserved.