Soft Tissue Deficiency Research Articles

Subscapularis Tendon Augmentation in Patients With Anterior Shoulder Instability Associated With Capsule-Labral Deficit

Shoulder instability is a common problem in young adults. Without surgical treatment, the recurrence rate is unacceptably high. While arthroscopic capsulolabral repair is popular for anterior glenohumeral instability, it still faces limitations. Surgical failures may arise from technical errors, soft tissue insufficiency, bone loss, or rehabilitation challenges. In cases with less than 15% glenoid bone loss and no external rotation deficit, subscapular augmentation provides an option without necessitating bone grafts or additional surgery. An arthroscopic technique is presented that utilizes the subscapularis tendon for tenodesis at the anterior edge of the glenoid ring in patients with the absence of capsulolabral tissue to provide both protection of the anterior glenohumeral aspect and a safer return to functional activities.

Use of De-Epithalialized Flap for Elevating the Alar Base in Patients With Cleft Lip.

Alar base asymmetry is a common problem in cleft lip patients. Caused by a lack of bone support and soft tissue deficiency, it is one of the problems that must be corrected during cleft lip repair. While it is encountered during primary lip repair, it can also be seen as a secondary cleft lip nasal deformity after repair. This study aimed to provide alar base symmetry with a de-epithelialized muscle-skin flap during the primary cleft lip repair of incomplete cleft lip patients and secondary cleft lip deformity repair. In incomplete cleft lip patients, the tissue under the incomplete part is de-epithelialized and elevated as a superiorly based flap. The flap is rotated and sutured under the alar base for the elevation. In secondary patients, scar tissue to be removed is de-epithelialized and elevated as a superiorly based flap. It is turned over and sutured under the alar base for augmentation. The effect of the surgery is monitored during the follow-up period. There were no complications related to the flap, and no volume loss was observed. Using a de-epithelialized musculocutaneous flap, the augmentation of the alar base and nasal sill can be achieved without additional incisions in patients undergoing primary incomplete cleft lip repair and in patients undergoing secondary cleft lip deformity repair. We think it is an effective and safe method, improving the esthetic outcomes of cleft lip patients.

Revision Reverse Total Shoulder Arthroplasty Using an Augmented Glenoid Baseplate: A Review of Current Glenoid Baseplate Options and a Case Report

Introduction: Total and hemi-shoulder arthroplasty have proved to be a safe and effective option for patients with symptomatic osteoarthritis. In some cases, glenoid implant failures or erosion can lead to acquired glenoid bone loss, complicating potential revision surgery. This paper presents a review of glenoid implant options for total shoulder arthroplasty and a case study which discusses a new augmented reverse baseplate for the revision of a failed hemi-shoulder arthroplasty. The patient was fully informed and gave written consent to submit the details of this case for publication in a peer-reviewed journal. Case Description: An 80-year-old retired professor with a prior history of right shoulder hemiarthroplasty presented with worsening right shoulder pain. She failed conservative care and wanted a conversion to a reverse total shoulder arthroplasty. The erosion on the patient's glenoid was severe enough for the surgeon to elect for the use of a metal augmented baseplate to fill the acquired defect and correct version and inclination. After an uneventful postoperative and recovery progression, at her one-year follow-up visit, she was pain-free and active, with significant improvements in her visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and active range of motion (ROM). Discussion: The advent of metal augmentation with advanced glenoid preparation instruments allows shoulder specialists the ability to address implant-associated acquired glenoid bone loss and soft tissue deficiencies with ease and confidence and reduce additional clinical challenges.

Peripheral nerve grafting

Peripheral nerve lesions often lead to significant and permanent loss of motor and sensory function. The aim of peripheral nerve grafting is to bridge nerve defects. When tension-free nerve repair is not possible, peripheral nerve grafting is indicated. Local infection, insufficient soft tissue coverage, significant muscle atrophy or joint contraction in case of "motor" nerve grafting, lack of microsurgical instruments or experience, life-threatening injuries. Exposure and preparation of the nerve stumps. Choosing and preparation of the donor nerve. Approximation. Nerve repair. Nerve reconstruction must always be tension-free as nerve repair with tension frequently leads to disruption of nerve healing and poor functional outcome. Autologous nerve grafting from various donor sites leads to excellent functional results with little sensory deficits at the donor regions. Limited immobilization, physiotherapy, ergotherapy, regular clinical and neurological assessments. Outcome of peripheral nerve grafting may, for example, depend on defect length, caliber and quality of the injured nerve, quality of the donor nerve, microsurgical expertise of the surgeon, time of reconstruction, and age of the patient.

Pelvic and Perineal Reconstruction.

After studying this article, the participant should be able to: 1. Classify types of bony pelvic resections. 2. Outline reconstructive options for pelvic and perineal defects. 3. Identify advantages and drawbacks of various reconstructive techniques. 4. Recognize the functional benefits of bony and soft-tissue reconstruction. Defects of the pelvis and perineum arise from tumors, trauma, infection, congenital differences, and gender incongruence. Pelvic resections can result in bony instability and soft-tissue deficiency. The goals of reconstruction are maintenance of spinopelvic continuity, elimination of dead space, resurfacing of cutaneous defects, and prevention of hernias. Perineal reconstruction has important functional considerations. Abdominoperineal resection and pelvic exenteration defects benefit from flap reconstruction to decrease pelvic wound complications. Vulvovaginal reconstruction is performed with flaps from the perineum, thigh, or abdomen. Scrotal and superficial penile defects are most commonly reconstructed with scrotal flaps and skin grafts. Total penile reconstruction most commonly uses a radial forearm free flap.

High-temperature emulsification coupled with low-temperature gelation for fabrication of agarose microsphere implants with well-controlled size for skin tissue enhancement.

Soft tissue deficiencies profoundly impact the daily lives, and mental well-being of patients. Microspheres facilitate collagen synthesis by establishing a conducive environment for fibroblast growth. Existing synthetic polymer microspheres are typically prepared through emulsification and cross-linking at normal temperatures. However, residues of cross-linking agents can adversely affect biocompatibility, thereby limiting their biomedical applications. Agarose has garnered significant attention owing to its biodegradability and excellent biocompatibility. We have for the first time developed high-temperature emulsification coupled with low-temperature gelation for fabrication of agarose microsphere implants with well-controlled size for skin tissue enhancement. The agarose microspheres exhibited favorable sphericity and dispersion, possessing a uniform particle size with an average diameter of 37.24 μm. Furthermore, the microspheres demonstrated commendable injectability and biodegradability. Additionally, the implants displayed remarkable biocompatibility, effectively promoting the proliferation of human foreskin fibroblast-1 (HFF-1) cells. The microspheres exhibited no systemic toxicity and induced no hemolytic or thermogenic reactions. In photoaged mice skin models, the agarose microspheres augmented dermal density, and enhanced skin elasticity. The microspheres showed the capacity to stimulate the regeneration of collagen fibers. The agarose microspheres offer a novel avenue for soft tissue filling and hold significance in the field of tissue engineering and skin regeneration.

Is revision to anatomic shoulder arthroplasty still an option? A systematic review.

With the historical complications when using total shoulder arthroplasty (TSA) to revise failed arthroplasties, and the success of the reverse prosthesis in the revision setting, the question arises whether revision to TSA is still a reasonable option? This systematic review examines revision to TSA and the factors associated with outcomes. A systematic review was performed for studies of TSA used to revise a failed hemiarthroplasty or TSA. The primary outcome was implant failure leading to a repeat revision arthroplasty. Secondary outcomes included visual analog scale (VAS) pain scores, shoulder motion and other clinical outcomes of shoulder function. Data were pooled to generate representative frequency-weighted means. Thirteen studies were included, totaling 312 shoulders. Etiologies for revision included glenoid arthrosis (62%), glenoid component failure (36%), and other (2%). Of which, 39% of cases experienced complications and 12% required another arthroplasty revision. Secondary outcomes such as VAS pain, Constant, ASES and UCLA score improved, but none were statistically significant. Unsatisfactory outcomes were higher among patients with glenoid bone loss, instability, and soft tissue deficiencies. Revision to anatomic TSA can be an acceptable option in certain patients. However, the high rate of complications and glenoid loosening, makes this a limited approach for a revision to anatomic TSA procedure.

Implant-Supported Vertical Soft Tissue Augmentation for Severe Hard and Soft Tissue Deficiencies at Malpositioned Implants: A Case Report of a Mucogingival and Restorative Approach.

The management of severe mucogingival deformities surrounding malpositioned implants represents a complex issue with a high risk of aesthetic failure. The present case report describes a mucogingival and restorative approach for the treatment of severe localized peri-implant tissue deficiencies with interproximal bone loss combined with an interproximal gingival recession on the adjacent natural tooth. This consists of maintaining a non-restorable malpositioned implant, submerging it through one or multiple vertical soft tissue augmentations, according to the defect severity, and delivering a tooth supported bridge involving the adjacent natural teeth. The step-by-step surgical technique adopted for implant submergence and vertical soft tissue grafting, as well as the subsequent surgical and prosthetic interventions, are described, presenting results at 5 years from implant submergence and 3 years from prosthetic finalization.

Implant-Supported Vertical Soft Tissue Augmentation for Severe Hard and Soft Tissue Deficiencies at Malpositioned Implants: A Case Report of a Mucogingival and Restorative Approach.

Implant-Supported Vertical Soft Tissue Augmentation for Severe Hard and Soft Tissue Deficiencies at Malpositioned Implants: A Case Report of a Mucogingival and Restorative Approach.

The Effects of Midfoot/Hindfoot Fusions on the Behaviour of Peroneus Longus Tendon in Adult-Acquired Flatfoot Deformity: A Biomechanical and Finite Element Analysis

Adult-acquired flatfoot has been considered to arise from tibialis posterior tendon deficiency. Recent evidence shows that arch stability is mainly maintained by structures such as plantar fascia and spring ligament. The dysfunction of these ’passive’ stabilizers results in loss of arch integrity that causes forefoot pronation and reactive tendon overload, especially in the tibialis posterior tendon and peroneus longus tendon. The peroneus longus tendon (PLT) spans several midfoot joints and overloads with arch lengthening. The biomechanical stress/changes that occurs in this tendon are not well recognized. This study evaluates the biomechanical consequences that fusions have on peroneus longus tendon stresses in soft-tissue deficiencies associated with flatfoot deformity. A complete computational human foot model was used to simulate different scenarios related to the flatfoot deformity and associated common midfoot/hindfoot fusions, to quantify the biomechanical changes in the peroneus longus tendon. The results showed that the stress of the peroneus longus tendon is especially affected by the fusion of hindfoot joints and depends on the soft tissue types that fail, causal in generating the flatfoot. These results could be useful to surgeons when evaluating the causes of flatfoot and the secondary effects of surgical treatments on tissues such as the peroneus longus tendon.

Hemifacial microsomia – a review of the literature of current hypotheses of pathogenesis, and possible therapeutic methods

<b>Introduction:</b> Hemifacial microsomia (HFM) is the second most common congenital craniofacial anomaly.<b>Aim:</b> The aim of this study is to review data related to HFM.<b>Materials and methods:</b> Materials for the review were selected based on an analysis of publications published in the last 10 years.<b>Results:</b> There are three possible models of pathogenesis – vascular abnormalities, Meckel’s cartilage damage, and abnormal development of cranial neural crest cells – caused by genetic, maternal, and external factors. Symptoms results from disorders of structures originating from the first, and second branchial arches, most commonly resulting in mandibular hypoplasia, microtia or anotia, hypoplasia of the auditory ossicles, facial nerve paralysis, and soft tissue deficiency. The severity of the disorder varies greatly, depending on the number of structures involved, and the degree of penetration. The most common classification system (Orbit, Mandible, Ear, Nerve, Soft tissue; OMENS) has recently been proposed to assess the temporomandibular joint disc, and to assess disturbances originating from another structures. Other classifications such as FACIAL or ICHOM criteria have also been developed. The approach to treating each case should be individualized, primarily focusing on reconstructing the underdeveloped mandible, orthodontic treatment, creating the external ear, and filling soft tissue deficiencies.<b>Discussion:</b> The complexity of the condition is noted, as well as the need for interdisciplinary patient care.<b>Conclusions:</b> Through analysis of existing research, and clinical data, significant information regarding etiology, symptoms, possible classification systems, and therapeutic options has been gathered.

A novel surgical technique to resolve mucosal fenestration of a root apex: Apical tunnel surgery: A case report.

Endodontic surgery, which includes apex resection, retro-fill and some regeneration procedures, is a traditional way to deal with apex fenestration. The endodontic surgery could bring large flap, curtate root length, non-healing mucosa and soft tissue deficiency in the apex area. Other treatment options might be considered according to different etiological factors. Mucogingival surgery provides some ideas in accumulation of soft and hard tissues, especially some unique methods such as "tunnel technique" bringing us a view of minimal invasive surgery approach. A novel surgery named "apical tunnel surgery" was reported here to resolve a root apex exposure with the tunnel-like technique. A young female complained about root exposure of upper right anterior tooth without history of trauma or orthodontic treatment. The intraoral examination revealed a buccal root apex exposure about 3mm in diameter of #12 (FDI teeth numbering system). The tooth was slightly dark with Class 1 mobility. The periodontal situation was good and the occlusion check revealed no traumatic bite on #12. The cone-beam computed tomography (CBCT) showed a bone fenestration from the buccally lower 1/2 root surface to the apex and bone absorption around the apex. It also revealed a bone contour deficiency in #12 area. Root canal treatment, root surface debridement, and soft tissue combined with hard tissue accumulation were carried out in one tunnel-like surgery. Examination of 12-month follow-up showed a healed and thickened mucosa in the buccally apical region and CBCT showed the continuous lamina dura occupied the buccal aspect of #12 root apex. This new apical tunnel surgery provided soft and hard tissue accumulation in one minimal invasive way in the apex exposure case caused by bone fenestration and thin mucosa.

Periodontal plastic surgery and regenerative periodontal surgery in a forty-seven-year-old patient with cleft lip and palate

Cleft lip and palate represent one of the most prevalent congenital malformations in humans, with an estimated prevalence of 0.45 per 1,000 individuals. During childhood and adolescence, affected patients undergo lengthy and complicated interdisciplinary treatment including treatment from specialists in pediatric medicine, oral and maxillofacial surgery, orthodontics, and otorhinolaryngology. The patient exhibited scarred adhesions with localized mucogingival deformities of the premaxilla (region 12 − 11), bilateral cleft lip and palate, and a complex underlying one-wall intrabony osseous defect on tooth 11, in addition to hard- and soft-tissue deficiencies at the dental implant in region 12. Following the administration of localized anti-infective periodontal therapy, regenerative periodontal surgery, regenerative surgical therapy of periimplantitis, and periodontal plastic surgery were performed. This resulted in a long-term, stable improvement in the clinical situation. Regenerative periodontal therapy and periodontal plastic surgery in patients with palato-alveolar cleft present a significant challenge due to the poor condition of the mucosa and gingiva adjacent to the defect and the insufficient bone dimensions. For this reason, it seems beneficial to include the periodontist in the interdisciplinary treatment team of a patient with cleft lip and palate from the outset. It is recommended that the patient be provided with dental prophylaxis measures and receive individualized oral hygiene instructions in addition to the main maxillofacial and orthodontic treatment. This approach would facilitate the identification of mucogingival issues at an early stage and the implementation of appropriate treatment.

A Systematic Review of Clinical Outcomes of Pedicled Flap Repairs of the Knee Extensor Mechanism.

Rupture of the extensor mechanism of the knee has severe functional morbidity, and repair can be complicated by infection, allograft degeneration, and recurrent rupture. Techniques of autologous tissue repair utilizing pedicled flaps such as the gastrocnemius offer vascularized methods of reconstruction, with potentially diminished complication rates. The goal of this study was to evaluate the functional outcomes and complications associated with pedicled flap repair of the knee extensor mechanism. A systematic review was conducted following the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. Publications that focused on local myocutaneous flaps as a means for reconstruction were included. Causes for knee extensor mechanism deficit, flap characteristics, ambulation rate, changes in range of motion pre- and postoperation, and postoperative complications were analyzed. Technique reports including primary suture repairs, synthetic mesh, and allograft use were excluded. An initial 119 studies were identified, with final review of 22 observational studies encompassing 128 cases of pedicled flap reconstructions. The gastrocnemius (88.2%, n = 113), quadriceps (6.3%, n = 8), and a combination of the vastus and gastrocnemius flaps (5.5%, n = 7), were the most frequently utilized flaps. Functional outcomes were favorable with 87.2% of patients achieving ambulation without external support. Variability in range of motion outcomes across different flap may be secondary to the patient characteristics as well as extent of initial injury. Autologous pedicle flap reconstruction of the knee extensor mechanism emerges as a viable option for cases characterized by extensive defects and insufficient soft tissue coverage, which are not amenable to direct suture repairs or allografts. Postoperative assessments revealed that the majority of patients experienced improved ambulation status, with no instances of deterioration noted among the patients.

An apically positioned flap and free gingival graft around an implant

Following the ‘2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions,’ hard and soft tissue deficiencies have been debated in the literature with keratinized mucosa at the forefront. In this case report, the present author investigated whether an apically positioned flap and free gingival graft to increase keratinized mucosa and vestibular depth improved oral hygiene and patient comfort around an implant-retained upper complete denture. Using an apically positioned flap in combination with free gingival graft to augment the soft tissues around implants with hard and soft tissue deficiencies, increased both the keratinized mucosa and vestibular depth to correct the soft tissue deficiencies. This case report highlights the importance keratinized mucosa and vestibular depth has at the patient and site level in improving oral hygiene and patient comfort. This case report also supports the growing evidence that the ideal periodontal phenotype around implants is to have keratinized mucosa ≥2 mm and vestibular depth ≥4 mm. CPD/Clinical Relevance: This case report supports growing evidence that the ideal periodontal phenotype around implants is to have keratinized mucosa ≥2 mm and vestibular depth ≥4 mm.

Aesthetic and Functional Reconstruction of Periorbital Region Using Radial Forearm Free Flap.

This study describes the utilization of the radial forearm free flap (RFFF) for the restoration of severe soft tissue deficiency involving the upper and lower eyelids in three patients. This study is a retrospective review of the senior authors' clinical records for patients who presented with periorbital defect and underwent reconstruction with RFFF between 2018 and 2022. As a part of a comprehensive reconstructive surgery, we used the RFFF to deliver an ample amount of well-vascularized soft tissue. The flap's vessels were anastomosed to the ipsilateral facial vessels in all cases. Patients showed significant functional improvement, with complete eyelid closure achieved. No immediate postoperative complications were noted. RFFF demonstrated optimal outcomes in upper eyelid reconstruction.

EARLY RESULTS OF SHOULDER ARTHRODESIS WITH 3D-TITANIUM IMPLANTS FOR TREATMENT OF SEVERE GUNSHOT WOUNDS OF THE SHOULDER GIRDLE

As a result of large-scale war in Ukraine, the frequency of gunshot wounds of the upper extremities has increased dramatically, accompanied by massive damage to soft tissue, neurovascular plexuses, and significant bone deficiency, so their treatment with traditional methods is risky. This leads to the development of new treatment methods, in particular, techniques for shoulder arthrodesis. Objective. To investigate the effectiveness of shoulder arthrodesis using an individual 3D-titanium implant and or a locked compression plate (LCP) with bone autoplasty for the treatment of severe combat trauma of the upper extremity. Methods. In 2022–2023, 19 men aged 36.2 (24–52) years with severe combat trauma of the upper extremity underwent shoulder arthrodesis using individual 3D-titanium implants (n = 9) or LCP with bone autoplasty (n = 10). The follow-up period was 18 months. Individual 3D-implants were created in the CAD program Autodesk Fusion 360 and made of Ti6AI4V alloy by three- dimensional metal 3D-printing. The functional status of the shoulder joint was assessed by the Oxford Shoulder Score, VAS at 6 and 12 months after surgery. Fusion was checked radiographically at 1, 3, 6 and 12 months. Results. The average follow-up period was 12 months. Ankylosis of the shoulder joint was formed in 18 (95 %) patients, and clinical consolidation without final restructuring with a positive tendency to bone fusion was detected in one patient (5 %). Radiologically confirmed fusion in 8.5 months (6–12). After 12 months, a decrease in pain (VAS: 5 to 1 points; p < 0.001) and improvement in the condition of the shoulder (Oxford Shoulder Score: 25 to 40 points, p < 0.001) were found compared with 6 months. Conclusions. Treatment of severe combat trauma of the upper extremity by shoulder arthrodesis allows to eliminate pain and restore sufficient function to perform daily tasks one year after surgery. The combination of shoulder arthrodesis with individual 3D-implants resulted in the restoration of upper limb function in all 9 patients with massive bone and muscle defects.

Specific complications associated with shoulder joint replacement

Complications such as scapular notching or artery, nerve and deltoid muscle damage can outweigh the benefits of shoulder joint replacement and result in poor functional outcomes. Reverse shoulder joint replacement may cause traction deformation of the brachial plexus and axillary vessels due to constructive medialistion and distalisation of the shoulder component. Delayed surgery after a fracture can lead to bleeding from damage to the axillary artery wall during the release of scarred soft tissues. Although most neurological complications after reverse arthroplasty (RA) are reversible, some persist, particularly damage to the axillary nerve. These complications can occur due to various reasons such as the use of acute retractors, glenoidal cavity release and humerus traction with further distalisation. Fixing the scapular component with screws can damage the supra-scapular nerve. Deltoid muscle dysfunction remains a serious complication due to axillary nerve damage or muscle fibre ruptures. Notching syndrome occurs when the shoulder component of the endoprosthesis collides with the scapula. Shoulder component dislocation, often caused by insufficient soft tissue tension due to implant misplacement, is not uncommon.This study was necessitated by the significance of these complications, their varied causes, the relative rarity of reverse arthroplasty, previous shoulder trauma altering anatomy, poor functional outcomes, and diverse problem-solving approaches.

Impact of Non-Surgical and Surgically Assisted Rapid Maxillary Expansion Procedures upon the Periodontium: A Systematic Review

Background: Scarce evidence is available regarding the occurrence and prevalence of hard/soft tissue deficiencies among patients undergoing surgically assisted rapid maxillary expansion (SARME) as compared to non-surgical rapid maxillary expansion (NSRME) approaches. The purpose of this study is to evaluate the effect of NSRME and SARME upon the periodontal structures. Methods: A literature search was performed to identify studies that fulfilled pre-established eligibility criteria, evaluating changes in the periodontium (e.g., probing depths) and hard/soft tissue deficiencies (e.g., bone levels, gingival recession) within patients undergoing NSRME and SARME procedures. Results: A total of 21 articles were included in the present review. Four of them evaluated the outcomes of both NSRME and SARME procedures, while six and eleven studies analyzed NSRME alone and SARME alone, respectively. The incidence of hard (e.g., changes in buccal bone width/height) and soft tissue deficiencies (e.g., gingival recession, keratinized tissue, and clinical attachment level) is slightly increased among patients undergoing maxillary expansion with worsened outcomes during NSRME procedures. Conclusions: The impact of NSRME and SARME upon the periodontium remains inconclusive.

Reverse shoulder arthroplasty megaprosthesis for surgical management of severe proximal humeral bone loss

IntroductionShoulder arthroplasty in the setting of severe proximal humerus bone loss can be challenging. The purpose of this study was to evaluate the outcomes of a modular segmental megaprosthesis when implanted in a reverse configuration for complex primary arthroplasty, reconstruction at the time of oncologic resection, and revision shoulder arthroplasty. Materials and MethodsA Joint Registry Database was queried to identify all shoulder arthroplasties performed at a single institution using the Comprehensive Segmental Revision System® reverse shoulder arthroplasty (SRS-RSA, Zimmer Biomet, Warsaw, IN, USA). A retrospective review of electronic medical records and radiographs was performed to record demographic data, indication, outcomes, complications, and revision surgery. ResultsBetween February 2012 and October 2022, 76 consecutive SRS-RSA were implanted. An analysis of patients with minimum 12-month follow-up yielded 53 patients with a mean follow-up of 4.1 ± 2.43 years. Surgical complication rate in this cohort was observed in 41.5% (22/53) of cases. Overall, revision rate at final follow-up was 26.4% (14/53), with a significant difference between the primary and revision cohorts. The number of prior surgeries was a significant risk factor for revision surgery, with a hazard ratio of 1.789 (p<.001 95%CI [1.314-2.436]). When analyzing aseptic humeral loosening rates across study cohorts, a significant difference was found between the primary arthroplasty (0%, n = 0) and the revision arthroplasty cohorts (22.2%, n = 6) (p = 0.04). DiscussionReverse shoulder arthroplasty using a modular segmental megaprosthesis remains a reasonable salvage option for shoulder reconstruction in the setting of proximal humeral bone loss. Due to the substantial bone loss and soft tissue deficiencies typically present in these cases, surgeons should educate patients on the relatively high complication rate, particularly when used in the setting of a previous failed arthroplasty.