Effectiveness of Clavicula Pro Humero Reconstruction for Elderly Patients: Report of Two Cases

Okimatsu, Sho; Kamoda, Hiroto; Yonemoto, Tsukasa; Iwata, Shintaro; Ishii, Takeshi

doi:10.1155/2016/4140239

Cited by 2 publications

(1 citation statement)

References 22 publications

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“…These published cases have revealed that CPH can maintain shoulder stability with comparable mobility (average 75° on flexion) and superior Musculoskeletal Tumor Society (MSTS) functionality scores (83%) [ 10 , 11 ]. However, the published complication rates for this procedure are high, with a substantial number of documented postoperative complications requiring surgical revision (Supplemental Table 1 ) [ 8 , 12 – 20 ]. The largest pediatric case series assessing postoperative outcomes following CPH for proximal humerus reconstruction revealed proximal nonunion requiring revision surgery occurred in five of seven patients (71%) [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Free Vascularized Fibula Salvage of Failed CPH in Pediatric Sarcoma Patients

Pires

Moss

Luo

et al. 2022

Sarcoma

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Background. Due to extended life expectancy and recent improvements in surgical techniques, limb salvage has replaced amputation as the gold standard and is now performed in 90–95% of upper extremity malignancies. However, many of these salvage procedures are associated with significant postsurgical complications. In particular, the clavicula pro humero (CPH) procedure is associated with high rates of nonunion. We present our experience with upper extremity salvage using the free vascularized fibular flap (VFF) after failure or nonunion of the original CPH procedure in the pediatric population. Methods. Five patients under the age of 18 diagnosed with upper extremity sarcoma who underwent tumor resection with immediate CPH reconstruction complicated with nonunion, and subsequent revision with free VFF were included. Data on patient demographics, oncologic characteristics, surgical procedures, intraoperative details, postoperative complications, and time to graft union were recorded. Results. Five patients (average age = 8.4 years; range = 5–10 years at surgery date) underwent secondary limb salvage procedure with free VFF reconstruction following failed CPH reconstruction for proximal humeral osteosarcoma (n = 4) or Ewing sarcoma (n = 1). The mean follow-up was 3.7 years. Complications occurred in five patients (100%), with three patients requiring reoperation (60%). Four patients achieved graft union (average union time = 3.7 months) and successful limb reconstruction. Four patients were alive with no local recurrence of the disease. One patient did not achieve union and was lost to follow-up. Conclusion. Primary bone tumors in the pediatric population require wide surgical resection, and reconstruction often has high complication rates that can warrant further procedures. A free VFF is a viable option for upper extremity salvage after previously failed reconstructions because it provides vascularized tissue to a scarred tissue bed and allows for the replacement or augmentation of large bony defects.

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