Journal of Experimental & Clinical Cancer Research 2009, 28:45 http://www.jeccr.com/content/28/1/45 (RF#iag3d)uiorgera6phs and photograph of the patient with myeloma Radiographs and photograph of the patient with myeloma (#3). The plain radiograph shows an expansive lesion in the glenoid, neck, and border of the scapula. rence and pulmonary metastasis [17]. Since patient #6 presented with the same features and potential damage as a malignant scapular tumor, we elected to treat this patient with wide resection. In general, an adequate surgical margin was achieved based on a favorable histological type and surgical stage along with the requisite adjuvant therapy. Therefore, a wide marginal resection that permits the secure reattach- ment of the important soft tissues of the shoulder should be a therapeutic goal in these patients. Most rotator cuffs, external rotators, and muscles around the thoracoscapula were sacrificed to obtain a safe surgical margin. Nonethe- less, we paid particular attention to restoration of essential shoulder abduction, flexion and stability in order to meet out patient' post-operative needs. It should be noted that the relatively intact deltoid and articular capsule are requi- site for achieving the desired level of motion and stability. The initial incision was considered a key factor in obtain- ing an adequate surgical margin and optimal reconstruc- tion. The incision site and subsequent course was determined with several important goals in mind. One was to expose the bony and muscular elements of the tTFhhiegeuspcrlaeapin7ulraardaiollogrgarpafhtyr2ec0omnsotnrtuhcstioafnter the procedure shows The plain radiography 20 months after the procedure shows the scapular allograft reconstruction. The local I125 radiotherapy placed around scapular muscles is shown. The union of the scapular allograft is apparent and there is no dislocation of the shoulder joint. region while providing adequate exposure for allograft reconstruction. Another was to minimize the loss of the uninvolved soft tissue (an opinion which is consistent with other experts in this field [18]). The incision was cen- tered in the middle of each tumor, thus a long posterior/ superior approach like an inverted L-shaped incision was predominantly utilized to permit complete exposure of the scapular spine, acromion, and coracoid process and to facilitating internal fixation. Since there was a limitation in exposure for the larger tumors located at the lateral bor- der of the scapula using with this approach, a lateral verti- cal incision was made for tumors occurring at this location; however, the anterior and posterior deltoid can not be freed or reconstructed easily from this approach. It should also be noted that the former surgical approach is superior to the later for covering the scapular allografts with a latissimus dorsi flap and facilitating glenoid-saved reconstruction, but if the posterior/superior incision was adopted for tumors located in the lateral border of the scapula, the excessive freed latissimus dorsi flap could be a risk factor for flap necrosis. In addition, the long inci- Page 7 of 10 (page number not for citation purposes)