Is polypropylene mesh reconstruction functionally superior to non reconstructive group following total scapular resection? A retrospective analysis of 16 patients and a systematic review of the literature

Abstract

Background: Various reconstruction methods have been described in medical literature on scapular tumor resection depending on the type of resection and other factors. However the ideal method of reconstructions has been still debatable. The purpose of the current study was to assess whether polypropylene mesh reconstruction is superior as compared to non reconstructive group following total scapular resection.We also evaluated how our method of reconstruction fare as compared to reported reconstruction methods in the published literature.

Methods: During 2014 to 2019; Total scapulectomy (Type III scapular resection) was performed in 16 patients for malignant tumor involving scapula bone. Reconstruction with polyprolene mesh(Group I) was performed in 56 % patient and non reconstruction technique (Group II) was observed in 44 % patient. The mean follow-up duration of current study was 28.3 months (range 13-67 months). The search method of PubMed and Cochrane databases provided 121 articles; of which 5 studies having 144 cases were utilised for final analysis. The reconstruction method used were dynamic humeral suspension (39.5%), non reconstruction method (35 %), scapular prosthesis (18 %) and static humeral suspension (5.5%).

Results: The mean Musculoskeletal tumor society score (MSTS) of the study cohort was 19.8(0-23); and that in polyprolene mesh or static suspension method (Group I) and non reconstructive technique (Group II) was 67 % and 61% respectively. The emotional acceptance score in group I was 4.5 and that in group II was 4.2 points. There was no difference in the shoulder movements in both the groups. The mean surgical durations in group I and group II was was 186 min and 140 min respectively. The systematic review showed the mean Musculoskeletal tumor society score (MSTS) of dynamic suspension and non reconstruction method were 63 % and 63.5% respectively. The mean Musculoskeletal tumor society score (MSTS) of scapula prosthesis tended to be higher than those with dynamic suspension (77 % vs 65 %).

Conclusions: The reconstruction with polypropylene mesh had better functional outcome and emotional acceptance as compared to non-reconstructive group in patients with total scapular resection surgery. The findings of systematic review suggest that; patients treated by reconstruction with polypropylene mesh and non-reconstructive group as compared to scapular prosthesis had limited shoulder movements with no difference in hand position, manual dexterity and lifting ability.

Keywords: Non reconstruction method; Polypropylene mesh reconstruction; Static humeral suspension; Total scapulectomy; Type III scapulectomy.