The stubborn shoulder: Pedicled scapula flap to salvage a complicated shoulder arthrodesis, a case report

Abstract

Shoulder arthrodesis is generally considered a last resort procedure for patients with refractory shoulder pain or instability due to brachial plexus injuries, arthritis, trauma, or following resection of a neoplasm. Failure of a shoulder arthrodesis is thus a devastating and highly challenging complication with limited salvage options. Various factors may inhibit bone healing including inadequate fixation, poor bone stock, and poor bone surface preparation [1]. For effective bony fusion, vascularized bone stock is preferential to promote osseous regeneration [[2], [3], [4]]. Patients requiring shoulder arthrodesis have often undergone multiple procedures to the glenohumeral region rendering the area relatively devoid of normally perfused tissue. There are multiple adjuncts to encourage bone regeneration. Among the more effective options is transfer of vascularized tissue to the site. Here we present a patient with chronic pseudoarthrosis following shoulder arthrodesis and multiple attempts at revision. Given a lack of vascular recipient options, a pedicled osteofascial flap from the scapula was performed to introduce vascularized bone to the joint.