Journal of Experimental & Clinical Cancer Research 2009, 28:45 http://www.jeccr.com/content/28/1/45 (FR#aig1d)uiorgera1phs of the patient with primary chondrosarcoma Radiographs of the patient with primary chondrosar- coma (#1). (A) The plain radiograph shows a lytic bony lesion in S2. The other lesion in the proximal humerus was identified as chondroma. rotator cuff, particularly the supraspinatus, infraspinatus, and subscapularis, were excised, similar to the external rotator muscles. Most of the affected muscles surrounding the thoracoscapula required en bloc excision with the tumor. The suprascapular nerve and blood vessel bundle required removal in only one patient (#1). The affected muscles were commonly characterized intraoperatively as swollen, necrotic, and deficient in elasticity/contractibil- ity. Following excision of affected soft tissues, resection of the acromion base and coracoid process (with preservation of the tips) was performed in all patients. Subsequently, the distal end of the clavicle was resected in patient #2 and the normal glenoid (in patients #2, 3, 6, and 7) was osteomized longitudinally at least 1 cm medial to the gle- noid edge in sequence while preserving the glenoid artic- eFCxiogpmuanrpdeuitn2egdintotomtohgeraspuhryrosucnadninshgomwusscthlees scapular lesion Computed tomography scan shows the scapular lesion expanding into the surrounding muscles. ular capsule and surface (in the glenoid-saved group). Alternatively, for the patients with an involved glenoid (#1, 4, and 5), the glenoid was resected together with the articular surface through an additional incision of the cap- sule (i.e., the glenoid-resected group). Finally, the affected scapula bodies were resected (in patients #1, 2, 3, 5, and 6) based on analysis of the intraoperative frozen sections that were taken to determine the surgical margins. A wide resection and safe surgical margin was selected for all patients. Bone and soft tissue management The articular capsule and muscles, particularly the abduc- tors, were reconstructed in sequence following bony reconstruction. The fresh-frozen (-80°C) scapular allo- grafts were provided by the bone bank at the authors' medical institution. Size-matched scapula allografts were placed to fit the bone defect, with a posterior glenoid tilt angle of 8° to 12° and a downward slope angle of 4° of the glenoid fossa. Fixtures used for the glenoid-saved allo- grafts depended on the thickness of the remaining gle- noid. When the glenoid thickness exceeded 1 cm, the allograft was fixed proximal to the lateral border of the scapula. For patients with a glenoid thickness of less than 1 cm, the articular capsule was instead sutured through holes created at the glenoid edge. The residual scapula were fixed to the glenoid-resected allografts with plates and screws and the articular capsule was sutured circum- ferentially via holes created in the allograft's glenoid edge. The tip of the coracoid and acrimion were fixed to the cor- responding allografts with absorbable screws, sutures, or reconstructive plates to restore the superior suspensory shoulder complex. Overall, two or more plates were shaped and implanted on the glenoid, spine, or the lateral and medial borders of the scapula according to the size and location of the allo- grafts. These plates were then used to fix the host scapula Page 4 of 10 (page number not for citation purposes)