Abstract
Resection of large lipomatous tumours in the subdeltoid region remains technically challenging due to the risk of injury to the axillary neurovascular bundle. We describe a novel deltoid release and reinsertion technique for resection of large lipomatous tumours of the sub-deltoid region and report the functional and oncologic outcomes of six patients who underwent this procedure. Three cases were diagnosed histologically as atypical lipoma and three cases were diagnosed as lipoma. There was one local recurrence in a case of an atypical lipoma. Rotator cuff function was comparable to that of the contralateral side in all cases and the average Constant Score adopted by the European Shoulder and Elbow Society was 84 (range 81 to 92) out of 100. We conclude that patients with large sub-deltoid lipomatous tumours who undergo resection through a previously undescribed deltoid release and reinsertion technique have excellent functional outcome with a low risk for recurrence.
Highlights
The upper extremity is affected by bone and soft tissue neoplasms one-third as often as the lower extremity [1]
When soft tissue tumours occur in the upper extremity, these tumours characteristically occur in the shoulder girdle
The deltoid muscle has a multipennate origin from the lateral third of the clavicle, the acromion process and the spine of scapula, and is the largest muscle of the shoulder girdle
Summary
The upper extremity is affected by bone and soft tissue neoplasms one-third as often as the lower extremity [1]. When soft tissue tumours occur in the upper extremity, these tumours characteristically occur in the shoulder girdle. The shoulder, is a region where these tumours may present difficulty in adequate resection due to the proximity of the tumour to neurovascular structures and the functional loss associated with periscapular muscle resection. The axillary nerve exits in the quadrangular space below the lower border of teres minor, where it passes around posterior and lateral to the humerus on the deep surface of the deltoid muscle. The nerve splits into anterior and posterior trunks, both of which run intimately with the deep surface of the deltoid muscle. Tumours in the sub-deltoid region are difficult to resect due to the risk of injury to the axillary nerve [4]. Various techniques of deltoid mobilization have been described, and these techniques vary in the approach and extent of detachment of the deltoid muscle from its origin or insertion [5–7]
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