title: Scapular allograft reconstruction after total scapulectomy: surgical technique and functional results.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Capanna
authors.affiliation: Department of Orthopedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Totti
authors.affiliation: Department of Orthopedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Ingrid C M
authors.initials: IC
authors.lastname: Van der Geest
authors.affiliation: Department of Orthopedic Surgery, University Hospital Balgrist, Zurich, Switzerland. Electronic address: daniel.mueller@balgrist.ch.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Müller
mesh_terms: D000328:Adult; D064591:Allografts; D001859:Bone Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery*; D012540:Scapula / Q000601:surgery* / Q000637:transplantation*
keywords: Scapula; allograft; limb salvage; orthopedic oncology; prosthesis; scapulectomy