Latissimus dorsi rotational flap combined with a custom-made scapular prosthesis after oncological surgical resection: a report of two patients

Abstract

BackgroundSarcomas that arise from the scapula or periscapular soft tissues often require a total scapulectomy. This often implies a large complex tissue defect that needs adequate reconstruction of both bone and soft tissue. Although various methods have been developed, no optimal procedure has emerged. Postoperative complications are common and functional recovery is not always satisfactory. This study aims to present a new surgical technique that combines a custom-made scapular prosthesis with a functional latissimus dorsi flap.Case presentationTwo patients diagnosed with malignant tumour of the scapular region were surgically treated after proper multidisciplinary evaluation. The first patient underwent the procedure as a first surgery, the second as revision surgery. The new technique comprises three surgical stages: excisional surgery with soft tissue resection and scapulectomy, bone reconstruction with custom-made prosthesis, and soft tissue reconstruction using a latissimus dorsi rotational flap overturned on the prosthesis. The goal is to set up a new functional unit combining an anatomically shaped implant (manufactured using latest three-dimensional printing technology) and a muscular flap, and to maintain the neurovascular supply. The patients were followed up to evaluate functional outcome and complications. Both patients were alive with no evidence of disease. Functional results were satisfactory and the Musculoskeletal Tumor Society scores were 87% and 63%, respectively. No surgical complications such as implant breakage, joint collapse, wound dehiscence, or infection were observed.ConclusionsThis new technique upgrades the role of the latissimus dorsi flap to a functional tool in combination with an anatomical, three-dimensionally printed, custom-made prosthesis, and provides adequate well-vascularized and healthy tissue to maximize the likelihood of successful limb salvage.

Application of a three-dimensional printed segmental scapula prosthesis in the treatment of scapula tumors

“…Beltram et al. 20 presented a customized scapula prosthesis replacement after tumor resection with an MSTS score of 87%. Liu et al.…”

Custom-Made 3D-Printed Implants as Novel Approach to Reconstructive Surgery after Oncologic Resection in Pediatric Patients

“…The development of custom-made implants represents the latest innovation in the field of limb salvage surgery after malignant bone tumors [ 18 , 19 ]. However, the application of this technology in the pediatric population has not been described until now.…”

“…As shown above, all of our patients except for two received a vascularized flap. Vascularized flaps provide a setting rich in substrates and reparative tissue around the titanium prostheses [ 18 , 22 ], which may favor osseointegration.…”

Tension Pneumothorax: Is it Sarcoma or Pazopanib?

“…Complete surgical resection with negative margins is the widely used first-line treatment for primary synovial sarcoma without metastases [2]. The use of systemic chemotherapeutic agents such as doxorubicin and ifosfamide in the management of synovial sarcoma is controversial, however, it has been used in many cases reported in the literature [5][6][7], and is thought to help control distant metastases of synovial sarcoma [2]. In instances where patients fail chemotherapeutic agents, targeted therapeutic agents such as pazopanib are employed to treat metastatic soft tissue sarcomas [8].…”