What is Scapular Reconstruction?
Scapular reconstruction is a surgical procedure typically used to repair or restore the scapula (shoulder blade) following trauma, tumor resection, or severe deformity. The scapula plays a critical role in shoulder mobility and stability, and damage to it can significantly impair arm movement and function. Scapular reconstruction may involve the following techniques:
- Bone Grafts: Surgeons may use autografts (from the patient's own body) or allografts (donor bone) to replace damaged or missing parts of the scapula.
- Metal Implants or Plates: In cases of trauma or bone resection, metal plates and screws may be used to stabilize the scapula and allow proper healing.
- Soft Tissue Reconstruction: Tendons, muscles, and ligaments around the scapula may also need to be repaired to restore proper shoulder function.
Indications for Scapular Reconstruction
Scapular reconstruction is typically indicated in the following scenarios:
- Trauma: Fractures, severe injury, or dislocations
- Bone Tumors: Surgery to remove malignant tumors, for example, osteosarcoma that affects the scapula may require reconstruction to replace the excised bone
- Infection: Chronic osteomyelitis (bone infection) that damages the scapula
- Congenital Defects: Deformities present at birth that limit shoulder function
- Arthritis or Degenerative Diseases: Conditions that severely damage the scapular structure
Preparation for Scapular Reconstruction
Preoperative preparation for scapular reconstruction may include the following:
- A thorough medical evaluation, including physical examination, medical history review, and laboratory tests to ensure the patient is fit for surgery
- Detailed imaging studies, such as X-rays, CT scans, or MRIs to assess the extent of damage or tumor invasion in the scapula and surrounding tissues and to plan the procedure
- Informing your doctor of any allergies to medications, anesthesia, or latex
- Providing your physician with a list of any medications or supplements you are taking
- You may need to adjust or temporarily stop taking certain medications - especially those that can affect blood clotting
- Abstaining from food or drink for at least 8 hours prior to the surgery
Procedure for Scapular Reconstruction
Scapular reconstruction surgery is typically performed under general anesthesia and involves the following steps:
- The surgeon makes an incision over the shoulder blade, typically along the posterior (back) side of the shoulder.
- Muscles and soft tissues are carefully dissected to expose the scapula and the surrounding damaged areas.
- If the surgery is being performed due to bone cancer or infection, the affected portion of the scapula is removed along with any surrounding tissue or muscle that may be involved.
- If the surgery is performed for scapular fracture, the surgeon will clear the area of any damaged bone fragments and assess the stability of the remaining bone.
- Depending on the amount of bone removed, autografts or allografts may be used to reconstruct the scapula. Bone grafts are shaped to fit the defect and are then positioned in place.
- In cases of trauma, metal plates, screws, or rods may be used to stabilize the scapula and hold it in place while it heals. These implants may remain permanently or be removed later.
- If surrounding muscles, tendons, or ligaments have been damaged, soft tissue reconstruction may be necessary. This could involve repairing or reattaching tendons, or in some cases, using tissue grafts to replace lost muscle.
- Once the bone and soft tissue reconstruction is complete, the muscles and skin are carefully stitched back together, and a sterile dressing is applied to the wound.
Postoperative Care and Recovery
After surgery, the shoulder will be immobilized using a sling or brace for several weeks to protect the reconstruction and allow healing. Post-surgical pain is managed with medications, including opioids and anti-inflammatory drugs. A crucial part of recovery involves physical therapy, which focuses on restoring shoulder movement, strength, and function. Therapy usually begins with gentle range-of-motion exercises before progressing to strength training. Follow-up appointments will be scheduled to monitor progress and address any concerns.
Risks and Complications
Risks and complications associated with scapular reconstruction include:
- Infection
- Bleeding
- Implant failure
- Non-union
- Limited shoulder mobility
- General anesthesia risks
