Primary malignant bone tumors of the shoulder girdle: Surgical technique of resection and reconstruction

Limb ablation for tumors of the shoulder is a devastating procedure. Recent advances in preoperative investigative measures, adjuvant chemotherapy, and reconstructive techniques have resulted in an increased interest in limb-sparing resection. For limb-sparing procedures to present a viable alternative in these cases, recurrence rates must be comparable to those obtained with ablative surgery. In addition, the resection must result in an improvement over the status obtainable with prosthetic devices. Twenty-four patients underwent limb-salvage procedures of various forms for primary bone tumors of the shoulder girdle. At follow-up (average: 33 months), 19 patients were alive without disease, one was alive with disease, and four were dead. One patient had local recurrence. All surviving patients enjoyed nearly normal function of the distal extremity. Improvements in techniques of soft tissue reconstruction in an effort to gain function and stability after wide resection of these tumors are necessary. Results indicate that these limb-salvage attempts offer successful alternatives to mutilating and crippling proximal amputations of the upper extremity.