THE FLAG TECHNIQUE: PEDICLED FROZEN AUTOGRAFT RECONSTRUCTION FOR SHOULDER GIRDLE SARCOMAS-A REPORT OF THREE CASES

Abstract

Reconstruction of extra-articular shoulder resections is challenging. We present a novel method using the patient’s own pedicled proximal humerus and scapula, sterilized with liquid nitrogen cryoablation and recycled as an autograft. The technique was used for three patients with malignant tumors. We present the surgical technique and clinical outcomes. All patients had high-grade sarcomas of the proximal humerus requiring extra-articular resection. At surgery, the tumor-bearing shoulder girdle was exteriorized with wide margins and pedicled on the humerus via a medial scapula and clavicular osteotomy. The pedicled shoulder was then frozen in liquid nitrogen, the extraosseous tumor mass and non-viable muscle were removed and the residual shoulder girdle was re-implanted. Average follow up was 4.5 years. At the time of writing, all patients are alive without disease and have retained their original reconstructions. Scapulothoracic and elbow movements were preserved with stiff glenohumeral joints. One patient experienced an implant complication requiring surgery to remove a migrated Kirschner wire and to mesh reinforce the glenohumeral capsule. The flag technique is a reliable, low cost reconstructive option for extensive sarcomas of the shoulder girdle. A stiff glenohumeral joint with preserved scapulothoracic motion may be expected post-surgery.