A Successful Reconstruction Using a Frozen Autograft and a Pedicled Latissimus Dorsi Flap after a S12345B Shoulder Girdle Resection in a Patient with Osteosarcoma

Abstract

We present a case of high-grade osteosarcoma in the proximal humerus in an 8-year-old boy. Massive tumor expansion required a S12345B shoulder girdle resection according to the system of the Musculoskeletal Tumor Society. After wide resection, only a small portion of the distal humerus and none of the rotator cuff muscles would be spared. Because the humeral portion would be too short to support the stem and the soft tissue would be insufficient to cover prosthetic components, we designed a composite reconstruction using a frozen autograft and a pedicled muscle flap. At 2 years postoperatively, our patient exhibited good adaptation and had acquired fine dexterity of the upper limb. To our knowledge, this is the first report regarding a successful composite reconstruction after a S12345B shoulder girdle resection.

Inhibitory effect of icariin on osteosarcoma cell proliferation via the Wnt/β-catenin signaling pathway

“…Osteosarcoma, as a kind of malignant tumor derived from malignant interstitial cells, has certain osteoid characteristics, including a strong migration capacity and frequent systemic metastasis ( 1 ). The pathogenesis of osteosarcoma remains unclear and the osteosarcoma of osteoblasts is a clinically common form at present, which generally occurs in the metaphysis of long-tubular bone, but seldom in the axial skeleton ( 2 , 3 ).…”

Experience of total scapular excision for musculoskeletal tumor and reconstruction in eastern Asian countries

“…The ideal reconstruction would restore the excised bone and soft tissue to their preoperative condition; however, this is difficult to achieve using current medical technology, especially in the case of muscle reconstruction. If possible, some of the important muscles such as supraspinatus should be reconstructed with a latissimus dorsi flap [10] or other methods [11] , [12] . However, number of muscles that can be reconstructed by flap surgery is severely limited and it is impossible to reconstruct all the excised muscles surrounding scapula.…”

Coverage of complex defects of the shoulder girdle and posterior neck triangle following tumor resection

“…Our approach (mentioned in the introduction) is demonstrated in the case reports and utilizes only two pedicle muscle flaps: the latissimus dorsi and pectoralis major muscles. Although there are many different flaps around the shoulder girdle that could be utilized for reconstruction [1], [2], [3], [4], [5], [6], we prefer these two muscles because they are large (defects created post tumor resection are generally large in size) and reliable. Furthermore, the donor site morbidities for these two muscles are known to be minimal [10], [11].…”

“…Numerous pedicle and free flaps have been used to cover complex defects of the shoulder girdle and posterior neck triangle following tumor resection [1], [2], [3], [4], [5], [6], [7], [8]. However, the literature does not offer any choices of flap selection in these cases.…”