HOW I DO IT Total Scapulectomy and Constrained Reverse Total Shoulder Reconstruction for a Ewing's Sarcoma

Background: Total scapulectomy and intra-articular resection of the glenohumeral joint indicates the Malawer Type III shoulder girdle resection. Materials and Methods: The modified Tikhoff-Linberg total scapulectomy and constrained reverse total shoulder reconstruction for a Ewing's sarcoma of the scapula is presented. A combined approach has been used. The deltoid, trapezius, rhomboids, levator scapulae, latissimus dorsi, and serratus anterior were preserved. the tumor was removed en bloc by disarticulation of the acromioclavicular and the glenohumeral joints. The scapular prosthesis was suspended by the muscles. A constrained reverse humeral prosthesis was implanted after osteotomy of the humeral head. Results: There were no intraoperative or postoperative complications; surgical margin, were clear. At 12 months postoperatively, the patient has a stable and painless shoulder. Conclusion: The goal of shoulder reconstructions is to provide a stable and painless joint that allows positioning of the arm and hand in space. Compared to those patients left without a scapula reconstruction, prosthetic replacement of the scapula and shoulder partially restores abduction and external rotation and improves cosmesis. J. Surg. Oncol. 2009;100:611-615. (C) 2009 Wiley-Liss, Inc.