Proximal and Total Humerus Reconstruction With the Use of an Aortograft Mesh
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The shoulder is commonly affected by primary and metastatic tumors. Current surgical techniques for complex shoulder reconstruction frequently result in functional deficits and instability. A synthetic mesh used in vascular surgery has the biological properties to provide mechanical constraint and improve stability after tumor related shoulder reconstruction.
We describe (1) surgical technique using a synthetic mesh during humerus reconstructions; (2) functional level defined as shoulder ROM of patients undergoing the procedure; (3) incidence of postoperative dislocation and shoulder instability; and (4) complications associated with the use of the device.
We retrospectively reviewed 16 patients with proximal humerus replacements reconstructed with a synthetic mesh from February 2006 to July 2008. Patients were followed clinically and radiographically for a minimum of 13 months (mean, 26 months; range, 13–43 months).
There were no shoulder dislocations at the latest followup. The mean shoulder flexion was 43° (range, 15°–170°) and mean shoulder abduction of 38 (range, 15°–110°). The mean operative time was 121 minutes (range, 80–170 minutes) and the mean blood loss was 220 mL (range, 50–750 mL). One patient had a superficial wound infection and none a deep infection requiring removal of the graft or prosthesis.
The data suggest the use of a synthetic vascular mesh for proximal humerus reconstruction may reduce dislocations and facilitate soft tissue attachment and reconstruction after tumor resection.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
- 25.Kitagawa Y, Thai DM, Choong PF. Reconstructions of the shoulder following tumour resection. J Orthop Surg (Hong Kong). 2007;15:201–206.Google Scholar
- 37.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;78:1872–1888.Google Scholar
- 39.Petrovic P, Lotina S, Djordjevic M, Avramov S, Pfau J, Velimirovic D, Fabri M, Stojanov P, Savic D. Results of 132 PTFE (Gore-Tex) bifurcated graft implantations. J Cardiovasc Surg (Torino). 1989;30:897–901.Google Scholar
- 40.Picci P, Mercuri M, Ferrari S, Alberghini M, Briccoli A, Ferrari C, Pignotti E, Bacci G. Survival in high-grade osteosarcoma: improvement over 21 years at a single institution. Ann Oncol. 2009 Nov 4. [Epub ahead of print].Google Scholar
- 52.Yang Q, Li J, Yang Z, Li X, Li Z. Limb sparing surgery for bone tumours of the shoulder girdle: the oncological and functional results. Int Orthop. 2009 Aug 23. [Epub ahead of print].Google Scholar
- 53.Yang X, Tare RS, Partridge KA, Roach HI, Clarke NM, Howdle SM, Shakesheff KM, Oreffo RO. Induction of human osteoprogenitor chemotaxis, proliferation, differentiation, and bone formation by osteoblast stimulating factor-1/pleiotrophin: osteoconductive biomimetic scaffolds for tissue engineering. J Bone Miner Res. 2003;18:47–57.CrossRefPubMedGoogle Scholar