Proximal and total humerus reconstruction with the use of an aortograft mesh

Abstract

Background: The shoulder is commonly affected by primary and metastatic tumors. Current surgical techniques for complex shoulder reconstruction frequently result in functional deficits and instability. A synthetic mesh used in vascular surgery has the biological properties to provide mechanical constraint and improve stability after tumor related shoulder reconstruction.

Questions/purposes: We describe (1) surgical technique using a synthetic mesh during humerus reconstructions; (2) functional level defined as shoulder ROM of patients undergoing the procedure; (3) incidence of postoperative dislocation and shoulder instability; and (4) complications associated with the use of the device.

Methods: We retrospectively reviewed 16 patients with proximal humerus replacements reconstructed with a synthetic mesh from February 2006 to July 2008. Patients were followed clinically and radiographically for a minimum of 13 months (mean, 26 months; range, 13-43 months).

Results: There were no shoulder dislocations at the latest followup. The mean shoulder flexion was 43° (range, 15°-170°) and mean shoulder abduction of 38 (range, 15°-110°). The mean operative time was 121 minutes (range, 80-170 minutes) and the mean blood loss was 220 mL (range, 50-750 mL). One patient had a superficial wound infection and none a deep infection requiring removal of the graft or prosthesis.

Conclusions: The data suggest the use of a synthetic vascular mesh for proximal humerus reconstruction may reduce dislocations and facilitate soft tissue attachment and reconstruction after tumor resection.

Fig. 1

Aortograft mesh with proximal humerus replacement is shown.

Fig. 2

Identification of the level of resection of proximal humerus is shown.

Fig. 3

Soft tissue structures, capsule and rotator cuff muscles are tagged and identified for repair.

Fig. 4

The glenoid is visualized for anchoring of the aortograft mesh.

Fig. 5

The glenoid view with the aortograft secured in place is shown.

Fig. 6

A pursestring suture on the aortograft securing the neck of the prosthesis is shown.

Fig. 7

Attachment of soft tissue structures on the aortograft mesh and layered closure of the surgical incision are shown.