PMC5458686_01
a- 40 year old man presented with huge swelling in left upper arm and shoulder measuring 28 cms across (b), 32 cms vertical (c) and 87 cms circumference (d)
JOCR-7-102-g001.jpg
PMC5458686_01_JOCR-7-102-g001.jpg
F1
On measurement, tumour was 32 cms long, 28Cms wide and the circumference was 87Cms (Fig. 1).
X-Ray of the area showed complete destruction of upper half of the humerus with central calcification of the tumour mass.
JOCR-7-102-g002.jpg
PMC5458686_01_JOCR-7-102-g002.jpg
F2
X-Ray of the area showed complete destruction of upper half of the humerus with central calcification of the tumour mass (Fig 2).
CT Angiography showed extensive destruction of the osseous tissue with calcification & there appeared involvement of lateral aspect of scapula also. Blood flow in major vessels was normal without undue hyper vascularity in the tumour area & the tumour mass was pushing the thoracic cage inwards.
JOCR-7-102-g003.jpg
PMC5458686_01_JOCR-7-102-g003.jpg
F3
CT Angiography showed extensive destruction of the osseous tissue with calcification and there appeared involvement of lateral aspect of scapula also (Fig 3).
a - Osteotomy of the Clavicle. B - Identification of the Major Neuro-vascular Bundle and ligation. C- Soft tissue dissection. D- disarticulation of the limb with scapula. Ewound sutured over drain. F- Disarticulated Limb with Tumour.
JOCR-7-102-g004.jpg
PMC5458686_01_JOCR-7-102-g004.jpg
F4
Surgical Procedure (Fig 4): The patient was placed in a right lateral decubitus position to expose the thorax with the left upper extremity free. The clavicle was divided at the proximal third and carefully elevated to expose the subclavian artery, vein and brachial plexus (Fig 4a,b). Posteriorly, fasciocutaneous skin flaps were developed and all periscapular muscles were released (Fig 4c). This allowed the shoulder girdle to be freed and the whole extremity to fall away from the trunk along with the scapula (Fig 4d). The anterior and posterior skin flaps were used to close the defect primarily over a corrugated drain Fig 4 e).