The tikhoff‐linberg procedure in the treatment of sarcomas of the shoulder girdle

Abstract

The majority of patients with soft tissue or bone sarcomas of the upper extremity can be treated today with limb-saving procedures using combined modality therapies. For patients with a tumor in the shoulder area, sometimes an interscapulothoracic amputation is the only radical surgical treatment. However, in selected cases, in which the tumor does not involve the neurovascular bundle, a limb-sparing alternative might be the Tikhoff-Linberg resection. Normal function of the hand and forearm, with reasonable function of the elbow, can be maintained by this procedure. Four case histories are reported.

Total scapulectomy and constrained reverse total shoulder reconstruction for a Ewing's Sarcoma

“…Total en bloc scapulectomy and limb-salvage surgery is indicated for most low and high-grade primary sarcomas of the scapula and soft-tissue sarcomas that secondarily invade the bone, if an adequate soft tissue cuff can be obtained for surgical margins [2,4,5,[8][9][10][13][14][15]17,19]. Contraindications for the procedure include tumor extension into the axilla with involvement of the neurovascular bundle, and patient's inability or unwillingness to tolerate a limb-salvage operation [8][9][10]18].…”

Malignant bone and soft tissue tumors of the shoulder girdle a retrospective analysis of 30 operated cases

“…The original description (Linberg 1928) is that of an extraarticular scapular and humeral head resection (type VB, Malawer 1991) (Figure 1). When a Tikhoff-Linberg resection is performed, a functional spacer is needed to prevent flailing of the extremity and traction injury to the neurovascular bundle (Ham et al 1993) (Figures 2-4 for examples). Jensen and Johnston (1995) reported 19 proximal humeral resections and reconstructions for primary bone sarcomas.…”

“…In Jensen and Johnston's series (1995), 2 of 19 patients had a local recurrence. The use of type I resection in stage IIB disease is too dangerous in terms of local tumor control but, on the other hand, the common practice of performing type VB resection might not be justified in all patients although it is still performed , Gebhardt et al 1990, Malawer 1991, Ham et al 1993) since the reliability of different imaging modalities in defining preoperatively the invasion in and around the glenohumeral joint by stage IIB tumors of the proximal humerus cannot be adequately determined.…”

Tikhoff-Linberg procedure and chest wall resection for recurrent sarcoma of the shoulder girdle involving the chest wall

“…An absolute contraindication for this operation is tumor involvement of the neurovascular bundle [4]. Historically, tumor invasion of chest wall has also been considered a contraindication to the procedure [1][2][3][4][5][6]. We describe a case in which a recurrent sarcoma of the shoulder girdle with chest wall involvement was treated successfully with the Tikhoff-Linberg procedure modified to include chest wall resection.…”

“…In contrast to the forequarter amputation or shoulder disarticulation, the Tikhoff-Linberg procedure leaves the patient with a functional hand and forearm. Indications for this limbsparing procedure include high and low grade sarcomas of the scapula, proximal humerus, lateral clavicle, or periscapular soft tissues [2,3,6]. An absolute contraindication for this operation is tumor involvement of the neurovascular bundle [4].…”