Abstract
Bone tumors are infrequent within the scapula. Total scapulectomy with massive allograft reconstruction represents an attractive alternative to amputation when the whole scapula is invaded with tumor and the neurovascular bundle can be preserved during tumor resection. We report a case of resection of the scapula and proximal humerus for recurrent osteosarcoma with massive allograft reconstruction of the scapula and proximal humerus. A 22-year-old male patient was seen in February 1992 for a pathological fracture of the proximal left humerus. In July 1992, a resection of the proximal end of the humerus followed by a reconstruction with osteochondral allograft and nail osteosynthesis was performed. The postoperative course was uneventful. In September 2009, 17 years later, the patient presented with a huge tumor developed at the level of the scapula. There was no vascular or neurological symptom. Plain radiography showed an expansive osteolytic mass. CT scan demonstrated scapular and proximal humerus invasion. An extended assessment revealed the presence of two pulmonary nodules. The biopsy confirmed the recurrence of osteosarcoma. The indication of a resection of both the left scapula and the 1992 allograft which was completely invaded at its proximal portion and the complete reconstruction of the scapula and the proximal humerus with allograft was made. One year postoperatively, we note a favourable outcome in terms of musculoskeletal functions. Despite two resection surgeries of pulmonary nodules and chemotherapy treatments, the patient developed new lung metastases and an unfavourable outcome. Although shoulder function was almost completely eliminated following surgery, preservation of elbow, wrist and finger motion resulted in an acceptable level of postoperative limb function. This reconstruction appears to be an attractive technique to be used in similar cases. The necessity of a reliable tissue bank with quality allografts in sufficient number is paramount.
Highlights
Proximal humerus is the first location of primary tumors of the upper limb and the fourth for all primary malignancies [1] [2]
Amputation was the usual treatment in the past but its use had been greatly reduced due to in-depth preoperative assessment using cutting-edge imaging modalities, the effectiveness of adjuvant chemotherapy and the progress of surgical reconstruction techniques [2] [3]
We report a case of resection of the scapula and proximal humerus for recurrent osteosarcoma with massive allograft reconstruction of the scapula and proximal humerus
Summary
Proximal humerus is the first location of primary tumors of the upper limb and the fourth for all primary malignancies [1] [2]. Their management must meet three requirements: tumor resection, bone defect reconstruction and soft-tissue reconstruction to cover skeletal reconstruction [3]-[5]. Reconstruction techniques of the proximal humerus sarcoma are well known [5]-[9]. Scapula sarcoma reconstruction is highly complex surgical procedure and requires careful dissection due to its relationship with neurovascular structures such as brachial plexus and axillary blood vessels. We report a case of resection of the scapula and proximal humerus for recurrent osteosarcoma with massive allograft reconstruction of the scapula and proximal humerus
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