Limb-sparing resections of the shoulder girdle.
BACKGROUND
Limb-sparing surgeries around the shoulder girdle pose a surgical difficulty, because tumors arising in this location are frequently large at presentation, are juxtaposed to the neurovascular bundle, require en bloc resection of proportionally large amounts of bone and soft tissues, and necessitate complex resection and reconstruction.


METHODS
Between 1980 and 1997, we treated 134 patients who presented with 110 primary malignant, 12 metastatic, and 12 benign aggressive bone and soft tissue tumors of the shoulder girdle and subsequently underwent a limb-sparing resection. Reconstruction of the bone defect included 92 proximal humerus and 9 scapular prostheses. All patients were followed up for a minimum of 2 years. We summarize the principles of limb-sparing resections of the shoulder girdle, with emphasis on the surgical anatomy of the shoulder girdle, principles of resection and reconstruction, and functional outcomes.


RESULTS
Function was estimated to be good or excellent in 101 patients (75.4%), moderate in 23 patients (17.1%), and poor in 10 patients (7.5%). Complications included 13 transient nerve palsies, 2 deep wound infections, and 1 prosthetic loosening. Local tumor recurrence occurred in 5 of 103 (4.9%) patients with primary sarcomas of the shoulder girdle.


CONCLUSIONS
Detailed preoperative evaluation and surgical planning are essential for performing a limb-sparing resection around the shoulder girdle. Local tumor control, associated with good functional outcomes, is achieved in the majority of patients.
Bickels
Jacob
J
Department of Orthopedic Oncology, Washington Cancer Institute, Washington Hospital Center, George Washington University, Washington, DC 20010, USA.
Wittig
James C
JC
Kollender
Yehuda
Y
Kellar-Graney
Kristen
K
Meller
Isaac
I
Malawer
Martin M
MM
D000328:Adult; D001132:Arm; D001859:Bone Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006811:Humerus / Q000601:surgery; D008297:Male; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D012540:Scapula / Q000601:surgery; D012782:Shoulder / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D013997:Time Factors