J Reconstr Microsurg 2012; 28(03): 155-160
DOI: 10.1055/s-0031-1296031
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Successful Reconstruction Using a Frozen Autograft and a Pedicled Latissimus Dorsi Flap after a S12345B Shoulder Girdle Resection in a Patient with Osteosarcoma

Takamasa Shimizu
1   Department of Orthopedic Surgery;
,
Akira Kido
1   Department of Orthopedic Surgery;
,
Kanya Honoki
1   Department of Orthopedic Surgery;
,
Keiichi Murata
1   Department of Orthopedic Surgery;
,
Hiromasa Fujii
1   Department of Orthopedic Surgery;
,
Banryoku Higuchi
2   Department of Pediatrics;
,
Takashi Ishihara
2   Department of Pediatrics;
,
Yasufumi Takeshita
2   Department of Pediatrics;
,
Midori Shima
2   Department of Pediatrics;
,
Hiroshi Yajima
1   Department of Orthopedic Surgery;
,
Manabu Akahane
3   Department of Public Health, Health Management and Policy, Nara Medical University School of Medicine, Nara, Japan.
,
Yasuhito Tanaka
1   Department of Orthopedic Surgery;
› Author Affiliations
Further Information

Publication History

08 May 2011

12 September 2011

Publication Date:
30 November 2011 (online)

Abstract

We present a case of high-grade osteosarcoma in the proximal humerus in an 8-year-old boy. Massive tumor expansion required a S12345B shoulder girdle resection according to the system of the Musculoskeletal Tumor Society. After wide resection, only a small portion of the distal humerus and none of the rotator cuff muscles would be spared. Because the humeral portion would be too short to support the stem and the soft tissue would be insufficient to cover prosthetic components, we designed a composite reconstruction using a frozen autograft and a pedicled muscle flap. At 2 years postoperatively, our patient exhibited good adaptation and had acquired fine dexterity of the upper limb. To our knowledge, this is the first report regarding a successful composite reconstruction after a S12345B shoulder girdle resection.

 
  • References

  • 1 Malawer MM, Witting J. Overview of resections around the shoulder girdle: anatomy, surgical considerations and classification. In: Malawer MM, Sugerbaker PH, eds. Musculoskeletal Cancer Surgery: Treatment of Sarcoma and Allied Diseases. 1st ed. Dordrecht, the Netherlands: Kluwer Academic Publishing; 2004: 179-202
  • 2 Asavamongkolkul A, Eckardt JJ, Eilber FR , et al. Endoprosthetic reconstruction for malignant upper extremity tumors. Clin Orthop Relat Res 1999; 360 (360) 207-220
  • 3 Bickels J, Wittig JC, Kollender Y, Kellar-Graney K, Meller I, Malawer MM. Limb-sparing resections of the shoulder girdle. J Am Coll Surg 2002; 194 (4) 422-435
  • 4 Wittig JC, Bickels J, Wodajo F, Kellar-Graney KL, Malawer MM. Constrained total scapula reconstruction after resection of a high-grade sarcoma. Clin Orthop Relat Res 2002; 397 (397) 143-155
  • 5 Bos G, Sim F, Pritchard D , et al. Prosthetic replacement of the proximal humerus. Clin Orthop Relat Res 1987; 224 (224) 178-191
  • 6 Capanna R, Giunti A, Biagini R , et al. Modular endoprosthesis for humerus and Tikhoff-Linberg resection. In: Yamamuro T, ed. New Developments for Limb Salvage in Musculoskeletal Tumors. Tokyo: Springer; 1989: 547-555
  • 7 Enneking WF, Dunham W, Gebhardt M, Malawar M, Pritchard D. A system for the classification of skeletal resections. Chir Organi Mov 1990; 75 (1, Suppl) 217-240
  • 8 Meyers PA, Gorlick R, Heller G , et al. Intensification of preoperative chemotherapy for osteogenic sarcoma: results of the Memorial Sloan-Kettering (T12) protocol. J Clin Oncol 1998; 16 (7) 2452-2458
  • 9 Tsuchiya H, Wan SL, Sakayama K, Yamamoto N, Nishida H, Tomita K. Reconstruction using an autograft containing tumour treated by liquid nitrogen. J Bone Joint Surg Br 2005; 87 (2) 218-225
  • 10 O’Connor MI, Sim FH, Chao EY. Limb salvage for neoplasms of the shoulder girdle. Intermediate reconstructive and functional results. J Bone Joint Surg Am 1996; 78 (12) 1872-1888
  • 11 Malawer MM, Meller I, Dunham WK. A new surgical classification system for shoulder-girdle resections. Analysis of 38 patients. Clin Orthop Relat Res 1991; 267 (267) 33-44
  • 12 Marcove RC, Lewis MM, Huvos AG. En bloc upper humeral interscapulo-thoracic resection. The Tikhoff-Linberg procedure. Clin Orthop Relat Res 1977; 124: 219-228
  • 13 Pritsch T, Bickels J, Wu CC, Squires MH, Malawer MM. Is scapular endoprosthesis functionally superior to humeral suspension?. Clin Orthop Relat Res 2007; 456: 188-195
  • 14 Gebhardt MC, Roth YF, Mankin HJ. Osteoarticular allografts for reconstruction in the proximal part of the humerus after excision of a musculoskeletal tumor. J Bone Joint Surg Am 1990; 72 (3) 334-345
  • 15 Wada T, Usui M, Isu K, Yamawakii S, Ishii S. Reconstruction and limb salvage after resection for malignant bone tumour of the proximal humerus. A sling procedure using a free vascularised fibular graft. J Bone Joint Surg Br 1999; 81 (5) 808-813
  • 16 Wilson PD, Lance EM. Surgical reconstruction of the skeleton following segmental resection for bone tumors. J Bone Joint Surg Am 1965; 47 (8) 1629-1656
  • 17 Behnam AB, Chen CM, Pusic AL , et al. The pedicled latissimus dorsi flap for shoulder reconstruction after sarcoma resection. Ann Surg Oncol 2007; 14 (5) 1591-1595
  • 18 Stern PJ, Carey JP. The latissimus dorsi flap for reconstruction of the brachium and shoulder. J Bone Joint Surg Am 1988; 70 (4) 526-535
  • 19 Malawer MM, Witting J. Proximal humerus resection: the Tikhoff-Linberg procedure and its modifications. In: Malawer MM, Sugerbaker PH, eds. Musculoskeletal Cancer Surgery: Treatment of Sarcoma and Allied Diseases. 1st ed. Dordrecht, the Netherlands: Kluwer Academic Publishing; 2004: 519-551