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Malignant tumors involving the shoulder girdle can arise from four distinct locations: the proximal humerus, scapula, periscapular muscles, and axillary structures. This article describes a utilitarian shoulder approach that can be used to resect these tumors.
The utilitarian shoulder approach can be used to resect shoulder girdle tumors. It accomplishes wide exposure of all shoulder girdle tumors and the adjacent neurovascular structures, facilitating mobilization and protection of all key structures and enabling adequate tumor resection.
Malignant tumors involving the shoulder girdle can arise from four distinct locations: the proximal humerus, scapula, periscapular muscles, and axillary structures (eg, axillary lymph nodes, nerves, and vessels). Surgical resection often is technically challenging as most tumors in these locations are large, juxtaposed to the axillary vessels and brachial plexus, involve multi - pie muscles, and often require resection via anterior and posterior exposure (Figure 1). An adequate surgical margin and a safe resection are best facilitated by complete exposure of the tumor and axillary vessels/brachial plexus.
To reduce the surgical complexity and complications associated with limbsparing surgery for tumors in this region, the senior author (M.M.M.) has developed an approach for resection, termed the utilitarian shoulder approach, which accomplishes safe exposure of the neurovascular structures; permits a reliable, wide excision of all tumors; and reduces morbidity associated with resections in this difficult anatomic area.1-4
The utilitarian shoulder approach is based on an incision with three arms: anterior (A), posterior (B), and anteroinferior (C) (Figure 2). The anterior approach (extended deltopectoral groove incision A) combined with detachment and mobilization of the pectoralis major and strap muscles (eg, coracobrachialis, short head of the biceps, pectoralis major), permits complete visualization of neurovascular structures (eg, the infraclavicular brachial plexus and axillary vessels). The posterior approach (B incision) accomplishes wide exposure of the scapula, deltoid, trapezius, rhomboids, and latissimus dorsi. The anteroinferior axillary incision (incision C) is a modification of the anterior approach that extends medially from the deltopectoral groove and curves into the axilla. It provides wide exposure of the axillary contents and is useful for large tumors in this area.
The success of the utilitarian shoulder approach is based on wide exposure and exploration of the tumor, axillary vessels, and brachial plexus. This facilitates mobilization and protection of all key...