The deltopectoral interval should not be utilized, because biopsy here would contaminate the deltopectoral fascia, the subscapularis, and pectoralis major muscles and would jeopardize the ability to perform an adequate resection through uninvolved tissue planes. For the definitive resection, the initial incision extends along the medial aspect of the biceps muscle, divides the pectoralis major, and exposes the neurovascular structures, thereby enabling the surgeon to determine resectability early in the dissection. This incision does not jeopardize construction of an anterior skin flap in patients who will require forequarter amputation. To avoid a positive margin at the site of humeral transection, the distal osteotomv is performed 6 cm distal to the area ot abnormality on the scan. Segmental reconstruction of the resultant humeral defect is necessary if resection is performed distal to the deltoid tuberosity.
Reconstruction is necessary to maintain length of the arm and to create a fulcrum for elbow flexion.
Rather, a custom prosthesis is fixed distally with methyl methacrylate into the remaining humerus and proximally with Dacron tape to the clavicle and remaining portion of the scapula. Principles of Shoulder Reconstruction Proximal soft tissue reconstruction is essential to cover the prosthesis and create shoulder stability. Dacron tape was utilized to secure the prosthesis horizontally. These two sets of Dacron tapes provide for mediolateral and craniocaudad stability. Motor reconstruction and soft tissue coverage is as follows.