Goal of Surgery

Radical resection of tumor. Preservation of the limb and of hand and elbow function.

Indications

Absolute: Primary, malignant bony or soft tissue tumors of the scapula, glenohumeral joint, or proximal humerus requiring extraarticular resection without opening of the glenohumeral joint.

Relative: Solitary metastasis.

Contraindications

Malignant tumors of scapula or humerus having a sufficient distance from the glenohumeral joint sufficient to proceed with an intraarticular resection.

Preoperative Work-Up

Routine staging.

Positioning and Anaesthesia

For resection type A: supine, for other types: lateral.

General anaesthesia.

Surgical Technique

Resection of the tumor includes resection of the proximal humerus, of glenohumeral joint, and of parts of or entire scapula. The surgical approach depends on the tumor site.

The incision for the Type A resection, described here, starts at the medial third of the clavicula and extends over the coracoid process toward the deltopectoral groove, including the scar of the biopsy incision. Replacement of the proximal humerus by a special prosthesis. Modifications applied in type B and C.

Postoperative Management

Velpeau dressing for 3 weeks in type A resection, 2 weeks in type B and 6 weeks in type C. Early active and passive motion exercises of hand and elbow.

Possible Complications

Injury to vessels and nerves, skin or soft tissue necrosis, loosening, breakage or dislocation of prosthesis. Recurrence of malignancy.

Results

Eight patients were operated. See Table 1.

Complications

No vessel or nerve damage. One breakage of prosthesis after fall, 1 clavicular fracture after type A resection and clavicula-pro-humero-reconstruction. 1 skin flap necrosis, 1 recurrence with metastases.