Journal of Experimental & Clinical Cancer Research 2009, 28:45 http://www.jeccr.com/content/28/1/45 Background For treatment of shoulder girdle tumors, scapulectomy and the Tikhoff-Linberg procedure were initially designed in an attempt to preserve hand and elbow performance. Unfortunately, functional impairment of the shoulder and the poor cosmetic outcome (e.g., flail arm) were widely described following these procedures. An array of other limb-sparing procedures for the treatment of shoul- der girdle tumors have also been documented [1-11] with variable results in relation to shoulder function. With recent improvements in effective adjuvant therapy and surgical techniques, restoring shoulder stability, preserv- ing a functional upper extremity, and rebuilding the shoulder contour after scapular tumor resection is feasible in many cases. Several reconstruction procedures for the scapula have been introduced over the last thirty years, including prosthesis or graft reconstruction of the shoul- der girdle. Total scapular prosthesis has proven itself to be a safe and reliable method for reconstructing the shoulder girdle after resection of bony and soft tissue tumors of the scapula. Further, good to excellent shoulder function and cosmetics have been reported for scapular prosthesis [5- 8]. The disadvantage of this procedure, however, is the insecure soft tissue reconstruction and the loss of the uninvolved proximal humerus. Scapular reconstruction using allografts following resec- tion of scapular tumors have rarely been reported. None- theless, osteoarticular acetabular allograft and scapular allograft reconstructions of the scapula have been described and are associated with a satisfactory functional and cosmetic result [2-4,12]; however, the surgical tech- nique and related clinical results have not been presented in detail. Therefore, the purpose of this study was to high- light the issues surrounding scapular allograft reconstruc- tion, including those associated with the incision, resection, surgical margin, and bone and soft tissue man- agement, and to present the clinical results of this proce- dure in a series of seven patients. Table 1: Patient Data Methods Patients Case details from seven patients (five males and two females) with scapular tumors who underwent scapular allograft reconstruction between 2004 and 2007 were reviewed. The average age of the patients was 37 years (range, 14–66 years). The diagnosis of every patient was established by preoperative biopsy. Five patients were diagnosed with primary malignant tumors of the scapula (two chondrosarcomas, one myeloma, one non-Hodg- kin's lymphoma, and one osteosarcoma) whereas the remaining two patients were diagnosed with aggressive benign tumors (primary and recurrent chondroblast- oma). The one patient with recurrent chondrosarcoma (#2) underwent tumor resection of the proximal humerus eight months before presenting to our hospital. Another patient (#6), with recurrent chondroblastoma underwent partial scapulectomy at an outside institution two months before presenting to our hospital. The patient with oste- osarcoma (#7) received neoadjuvant chemotherapy pre- and postsurgically. The patients with myeloma (#3) and malignant lymphoma (#4) received local intraoperative radiotherapy. Data for all patients, including gender, age, diagnosis, cancer stage, adjuvant therapy, time of follow-up, and reconstruction type, have been summarized in Table 1. All patients were staged by local radiography, magnetic reso- nance imaging, computed tomography, nuclear scintigra- phy (technetium bone scans), and preoperative biopsy. The resection and management of bone and muscle, together with the clinical results, have been provided in Table 2. Shoulder function was evaluated according to the International Society of Limb Salvage criteria (ISOLS) cri- teria [13], as shown in Table 3. Surgical approach The approach to the tumor for each patient was deter- mined by precise preoperative imaging studies. The pri- Patient Gender/Age (years) Diagnosis Stage Adjuvant therapy Followup (months) Glenoid-saved/resected reconsturction 1 2 3 4 5 6 7 M/38 M/29 M/66 F/29 M/46 F/40 M/14 CS RCS ML NHL CB RCB OS IB IB IB IIB 3 3 IB None None I125 I125 None None NAC 14 38 20 16 16 29 50 Glenoid-resected Glenoid-saved Glenoid-saved Glenoid-resected Glenoid-resected Glenoid-saved Glenoid-saved CS: chondrosarcoma, RCS: recurrent chondrosarcoma, ML: myeloma, NHL: non-Hodgkin lymphoma, CB: chondroblastoma, RCB: recurrent chondroblastoma, OS: osteosarcoma, NAC: neoadjuvant chemotherapy. Page 2 of 10 (page number not for citation purposes)