Limb-sparing resection of the scapula and reconstruction with a constrained total scapula prosthesis: a case of multicentric epithelioid hemangioendothelioma involving the scapula and surrounding soft tissues.

INTRODUCTION: The scapula is a relatively uncommon site for primary bone sarcomas. Tumors arising from the scapula are often initially contained by the rotator cuff muscles that protect pertinent adjacent muscles as well as the brachial plexus and axillary blood vessels. Limb-sparing resection of a scapula sarcoma is technically complex and requires meticulous dissection and mobilization of the brachial plexus and axillary blood vessels. Several muscles must be capable of being preserved in order to reconstruct the scapula and shoulder girdle with a special customized total scapula replacement. The goal of reconstruction is to restore a stable shoulder girdle to preserve elbow and hand function.

METHODS AND RESULTS: In the procedure demonstrated in this video, limb-sparing scapula resection and reconstruction was performed for a patient with a multicentric epithelioid hemangioendothelioma. The steps of the procedure are detailed along with accommodations made for the multicentric nature of the tumor. To allow for optimal postoperative function and maximum soft tissue coverage, a small constrained scapular prosthesis was utilized. The glenohumeral ligaments were reconstructed with a Gore-Tex aortic graft. Multiple muscle rotation flaps were performed to cover and protect the prosthesis as well as restore shoulder girdle stability.

CONCLUSION: Limb-sparing surgery for scapula sarcomas and anatomic reconstruction with a constrained total scapula prosthesis is a reliable and safe technique for resecting selected sarcomas and reconstructing the shoulder girdle. A stable shoulder girdle can be restored for optimal hand and elbow function. A total scapula prosthetic reconstruction is the authors' procedure of choice when the deltoid, trapezius, rhomboid, latissimus, and serratus anterior muscles are capable of being preserved. The functional outcome is superior to a forequarter amputation and a flail (nonreconstructed) shoulder in which the extremity is left hanging by soft tissues (nonanatomic method).