Surgical options in cases of tumorous destruction of the proximal humerus: twenty-one patients followed from 4-9 years.

PURPOSE: To compare the postoperative outcomes of several techniques of reconstructive surgery for malignant and aggressive benign tumors of the proximal humerus. PATIENTS AND METHODS: Twenty-one shoulder reconstructions following tumor resection were studied. Nine cases with an intracompartmental tumor were treated with endoprosthetic reconstruction. Three cases with the tumor involving the glenoid were treated with a typical Malawer VB shoulder girdle resection. In 5 patients with extracompartmental resections including the rotator cuff or the deltoid muscle a modified Tikhoff-Linberg procedure using polypropylene mesh was performed. In 4 patients with extracompartmental excision the authors proceeded to skeletal reconstruction using a modular endoprosthesis, while soft tissue reconstruction was undertaken using monofilament polypropylene mesh in order to enforce joint stability. RESULTS: All patients achieved stable shoulders. In cases where the technique was modified with mesh the functional outcome was fairly improved and the cosmetic result was excellent. CONCLUSION: For extracompartmental excisions including the deltoid or the rotator cuff the authors recommend a modified Tikhoff-Linberg procedure. Using polypropylene mesh they aim to achieve a static suspension in order to avoid the excessive traction of the neurovascular bundle, which is the most common complication of this procedure. Substitutionally such cases may be treated by reconstruction with a modular endoprosthesis. They recommend stabilization of the prosthesis with the use of mesh implant, avoiding in this way instability.

Reconstruction of tibia defects by ipsilateral vascularized fibula transposition.

INTRODUCTION: Segmental defects of the tibia after open fractures, sepsis and tumor surgery present a challenging problem. Similarly, tumor surgery often involves radical resections and multiple procedures and is frequently accompanied by irradiation or chemotherapy creating an avascular bed. The aim of this study is to report the results and discuss the role of the ipsilateral pedicle vascularized fibula (IPVF) a technique used for reconstruction of tibia defects. MATERIALS AND METHODS: Reconstruction of large tibia defects 6-22 cm due to tumor resection were performed in 5 patients by ipsilateral vascularized fibula transposition. The mean age of the patients was 35.4 years (19-42) SD 9.31. The mean follow-up was 59.6 months (24-96) SD 29.2. The mean length of the bone defect was 14.6 cm (6-22) SD 6.066 and the mean time for union was 8 months (6-12) SD 2.82. Arteriography was used preoperatively in all patients to evaluate the lower limb vasculature and to select the optimal surgical approach. The osteosynthesis was stabilized by a plate. RESULTS: There was sound union in all cases. There were only two minor complications one partial paresis of peroneal nerve and one superficial infection. The mean follow-up was 59.6 months (24-96) SD 29.2. No patient presented with any complaints with the procedure and all had good functional results. CONCLUSIONS: The procedure was technically simple compared to free vascularized fibula and could be performed in hospital with low resources. There are several advantages: (a) achievement of bone defect reconstruction retaining periosteal and endosteal circulation, (b) preservation of a major vessel of the lower leg, (c) avoidance of difficulty and risk of microvascular technique and (d) no donor-morbidity. We routinely recommend preoperative angiography and intraoperatively meticulous dissection to prevent damage to the vascular pedicle.