Journal of Experimental & Clinical Cancer Research 2009, 28:45 http://www.jeccr.com/content/28/1/45 to the allografts with screws. The resected partial clavicle of one patient (treated with alcohol devitalization) was fixed with a plate to its original position while the distal clavicles of the remaining six patients were bound with Dacron tape. After implanting the allografts, the abduction mechanism, including the deltoid and rotator cuffs, were reconstructed using the remaining muscles. Posteriorly, deltoid recon- struction was achieved in two patients by tenodesis to the trapezius and intraosseous sutures. The uninvolved del- toid was reattached to its stumps on the allograft, the host acromion process, or the clavicle. The remaining muscles were either sutured to their corresponding stumps or were tenodesed to predrilled holes in the allografts. Rotator cuff reattachment was achieved in four patients. The artic- ular capsule and deltoid were either well preserved and/or reconstructed in all seven patients. Two patients (#3 and 4) required local intraoperative radiotherapy in the mus- cles surrounding the scapular allograft using I125. Postoperative rehabilitation programs The upper extremity was placed in an abduction brace at a functional position for four weeks postoperatively. Range of motion (ROM) and motor strengthening exer- cises for the hand and elbow were performed immediately postoperatively and shoulder isometric exercises were ini- tiated within five days postoperatively. Later, isotonic and resistance muscle training were included in the patients' rehabilitation programs after removal of the brace. Results The median follow-up period for the seven patients fol- lowed in this case series was 26 months (range, 14–50 months). ISOLS-based functional scores ranged from 21 to 28 points (mean, 24) with a mean functional rating of 80% (range, 70–93%). As shown in Table 3, the range of active shoulder abduction and forward flexion motion were 40°–110°and 30°–90°, respectively and all patients retained a high degree of hand and elbow function. Satis- factory shoulder contour was achieved in all patients (Fig- ure 3, Figure 4, Figure 5). Three patients (#4, 6, and 7), whose rotator cuffs were resected, had lower total ISOLS scores (22, 21, and 23 points, respectively) than the other four patients and demonstrated a limited range of shoul- der abduction and flexion. The glenoid-saved reconstruction showed a mean ISOLS score of 24.5 points (81%), compared with 24 points (79%) in the glenoid-resected group of patients; however, the glenoid-saved patients had superior abduction/flexion motion than the glenoid-resected patients (mean, 72°/ 61° versus 55°/43°). Further, higher scores for emotional acceptance were recorded in the glenoid-saved allograft group than in the glenoid-resected patients. No correla- gTFrhiagefutprroesc3toonpsetrautcitvieonplain radiograph shows the scapular allo- The postoperative plain radiograph shows the scapu- lar allograft reconstruction. tion between the size of the lesion and the degree of post- surgical shoulder function was noted. Two patients had local recurrence during follow-up. One patient (#6), diagnosed originally with a recurrent aggres- sive chondroblastoma, had a local recurrence at 28 months postoperatively and died of the disease 36 months after surgery with an intact allograft. Another patient with a preoperative diagnosis of myeloma (#3) was alive at follow-up in spite of the recurrent cancer. One patient (#2) diagnosed preoperatively with chondrosar- coma underwent an additional surgery during the follow- up period due to development of osteochondroma in the proximal humerus. The remaining five patients were alive and tumor-free for the duration of the study follow-up period. In terms of postoperative complications, one patient (#2) acquired a deep infection at the distal end of the clavicle, which had been fixed during surgery with a plate. Removal of the plate and surgical debridement was per- formed 16 months postoperatively, but recovered une- ventfully thereafter. Another patient (#4) complained of shoulder pain throughout the follow-up period. There were no nonunions between the allografts and the host scapula, and no shoulder dislocations and articular Page 5 of 10 (page number not for citation purposes)