Functional outcome of limb sparing surgery of shoulder girdle tumors after free vascularized fibular flap.

Abstract

Objective: To share the functional outcome of free vascularized fibular flap for shoulder reconstruction using Toronto Extremity Salvage Score (TESS). Study Design: Descriptive Cross-sectional study. Setting: Burns and Plastic Surgery Center, Peshawar. Period: January 2019 to December 2023. Methods: All the patients presented with biopsy proven sarcoma involving proximal humerus were included in this study. Informed consent for data collection was obtained. Patient data regarding demographics, tumor location, extent of lesion, reconstruction and complications was collected from patient records. Six month follow up was done to assess functional recovery of the patient. Toronto Extremity Salvage Score (TESS) was used 6 months post-operatively to assess recovery of the patient using TESS questionnaire. Patient data was analyzed in using an open source software, GNU PSPP version 2.0.0. Results: A total of 11 patients were included in this study. Mean age of the patients was 15±3.5 years. Eight patients (72.7%) were male while 3 (27.3%) were female. Two patients has post-operative bleeding and 1 patient had fracture of fibula. Average TESS score was 61±7.71 years. Eight patients (72.7%) reported a good TESS score while 4 (27.3%) patients scored poor on TESSS Questionnire. Conclusion: Reconstruction of shoulder in sarcoma patients is a complex problem. Both prosthetic and biological reconstructive options present their own set of issues. In our experience, the use of free vascularized fibular flap (FVFF) presents a much better option with lower rate of infection and on average good Toronto Extremity Salvage Score (TESS) Scores.