2002 CTOS Annual Meeting Posters — Surgery

RECONSTRUCTION WITH SCAPULAR ENDORPROSTHESIS PROVIDES SUPERIOR RESULTS AFTER TOTAL SCAPULAR RESECTION: SURGICAL TECHNIQUE AND COMPARISON TO PATIENTS WITHOUT ENDOPROSTHETIC RECONSTRUCTION
[Abstract ID: 58]

Category: Surgery

Authors: Felasfa M Wodajo¹, Jacob Bickels², James C Wittig³, Kristen Kellar-Graney¹, Yehuda Kollender², Isaac Meller², Martin M Malawer¹

Author Institutions: ¹Washington Cancer Institute, DC, United States; ²Tel Aviv Sourasky Medical Center, Israel; ³NYU Medical Center Tisch Hospital, NY, United States

Presenter: Felasfa M Wodajo
felasfa@earthlink.net

Correspondent: Felasfa M Wodajo
felasfa@earthlink.net
Washington DC United States 20010
Ph: 202-877-7561
Fax: 202-877-8959

Objectives: Suspension of the humeral head from the clavicle after total scapular resection is compared to endoprosthetic scapular reconstruction. The surgical technique of endoprosthetic reconstruction and functional results are described.

Patients
23 patients with scapular tumors requiring total scapular resection were treated. Resection included 12 total scapulectomies and 11 en-bloc resections of the scapula and humeral head. Seven patients received endoprostheses. Four had prosthetic humeral heads suspended from the clavicle and 12 had suspension of the native humeral head. All patients were followed more than 2 years.

Methods: Endoprosthetic Surgical Technique

Patient selection was crucial. All peri-scapular muscles were tumor-free. Resection was usually performed using a posterior approach. Most high-grade scapula tumors were resected with the proximal humerus. Smaller than a natural scapula, the prosthesis facilitated soft-tissue reconstruction and was multiply fenestrated for myodesis. It was placed on the serratus anterior and covered by the rhomboids, trapezius and latissimus. A curved humeral head prosthesis was cemented into the humerus and connected to the scapular prosthesis using Gore-tex™.

Results: There were no deep wound infections, failures, or secondary amputations. Elbow range-of-motion and hand dexterity were similar. Patients with scapular endoprosthesis had better active abduction (60 - 90 vs. 10 - 20). Patients with endoprosthetic reconstruction had a more natural contour. 6 patients with scapular prostheses (86%) and 10 patients with humeral suspensions (62%) had a good-to-excellent functional outcome.