The sling procedure useful reconstruction method for wide defect of the proximal humerus: study

The proximal humerus is a common site for both primary and metastatic bone tumors. Although various methods have been developed for reconstruction following resection of the proximal humerus, a consensus on which technique is best has not been established.

Ryuto Tsuchiya et al focused on the sling procedure using a free vascularized fibular graft (FVFG). The study was conducted at National Cancer Center Hospital, Tokyo, Japan.

The authors retrospectively reviewed the data of 19 patients who underwent the sling procedure with use of an FVFG. The median age was 20 years, and the median follow-up duration was 63.1 months. Surgical data, oncological outcomes, the postoperative course, complications, and functional outcomes as measured with use of the Musculoskeletal Tumor Society (MSTS) score were thoroughly reviewed.

Key findings of the study were:

• The median operative duration was 555 minutes, and the median blood loss was 374 mL.

• The median length of the bone defect was 17.0 cm, and the median length of the graft was 20.0 cm.

• With respect to oncological outcomes, 9 patients were continuously disease-free, 9 patients had no evidence of disease, and 1 patient was alive with disease.

• Bone union was present in 13 of the 17 patients for whom it was evaluable.

• The median time to bone union was 4 months.

• Graft growth was observed in 2 pediatric patients.

• Postoperative fracture was a major complication at the recipient site.

• The incidence of pseudarthrosis significantly increased when the FVFG could not be inserted into the remaining humeral bone or was split in half (p = 0.002).

• Although a few patients demonstrated peroneal nerve palsy at the donor site, the symptom was temporary.

• The overall functional outcome was favorable, with an average MSTS score of 66.9%.

“In conclusion, we retrospectively reviewed the largest number of patients to date to undergo the sling procedure using an FVFG. This reconstruction method demonstrated a low complication rate and a favourable functional outcome overall. We therefore conclude that the sling procedure is beneficial for patients in a broad age range who have a wide defect of the proximal humerus” the authors commented.

Level of Evidence: Therapeutic Level IV.

Further reading:

Outcomes of Sling Procedure Using a Free Vascularized Fibular Graft After Resection of the Proximal Humerus

Ryuto Tsuchiya et al

JBJS Open Access 2023:e23.00044.

http://dx.doi.org/10.2106/JBJS.OA.23.00044