Case Study : Scapula resection and replacement for bone cancer (Full Shoulder Replacement)
Background Information


30 Year old gentleman from Iraq developed hard swelling of his right shoulder blade. Biopsy was performed in Iraq & a diagnosis of Osteogenic Sarcoma was made. He was given two cycles of Chemotherapy but the Tumor did not respond to this. He was advised amputation of his Right upper limb (Fore Quarter amputation) in Iraq. He took a second opinion in Syria where also he was advised that amputation was the only answer. At this stage he was referred to Action Cancer hospital, New Delhi, India for limb salvage surgery (Scapulectomy).

Scapula Bone Cancer

Challenges


Challenge in front of team of Orthopedic & Oncology surgeons headed by Dr.Suneel Kumar, Dr Amar Sarin & Dr.Rajesh Jain was two fold.

1. Firstly to remove the tumor in its entirety with wide margins

2. Secondly to reconstruct the shoulder girdle to give efficient fulcrum for the elbow, wrist & hand to function without any impediment. Scapular tumors are rare so the prosthesis for reconstruction is not available off the shelf.


Solution


After intense deliberation by the Surgical team over his X-rays, Isotope bone scan & MRI, they took up the challenge of saving his limb by removing his tumor & reconstructing his shoulder girdle (scapular replacement) by using a Custom made Scapula & shoulder prosthesis. A special constrained prosthesis of Titanium was designed & made exactly of the size of the patient’s shoulder blade using the measurements from CT scan

Custom Made Scapula

Shoulder Prosthesis


Procedure


First part of surgery was to resect the tumor (scapulectomty) which was achieved without looking at the tumor & ensuring that all the important nerves & blood vessels were not damaged. The resected tumor weighed 2.2 kgs. Second part of the surgery was to implant the custom made scapular prosthesis & to attach all the muscles to it. Then specially designed humeral prosthesis was fixed in place with bone cement. Next Scapular prosthesis was covered with a muscle flap raised from neighboring region. This state of the art surgical procedure took 6 hours.



Results


The result of this procedure was a total success. Additionally this was the first such procedure performed in India. Dr Sarin was proud to be associated and contribute extensively with his immense experience on such a landmark surgical success.



 Implant Custom Made Scapular

Doctor's Team



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