Functional reconstruction of the deltoid muscle following complete resection of musculoskeletal sarcoma

Although the deltoid muscle has been assumed to be an essential shoulder muscle, the full extent of postoperative functions of the upper extremity following its complete resection due to sarcoma has not been thoroughly investigated. In this study, we review patients who underwent wide resection for sarcoma in the deltoid muscle, followed by functional reconstruction using pedicled latissimus dorsi (LD) muscle transfer. Four patients with sarcoma arising in the deltoid muscle were reviewed. Tumor resection with a wide surgical margin resulted in loss of the entire deltoid muscle together with the axillary nerve. For reconstruction, the ipsilateral pedicled LD muscle was transferred on its neurovascular pedicle for use as a functional substitute. One case had local recurrence and the transferred LD myocutaneous flap was resected. There were no serious complications after the operation, and all flaps survived perfectly. Wound healing at both the recipient and donor sites was uneventful. Active abduction of the shoulder joint was >160° in all patients. The muscle manual test of shoulder flexion was good to normal and abduction was fair to good. Musculoskeletal Tumor Society scores were excellent in all cases and the average score was 92% (range, 87-93%). Our results suggest that removal of the entire deltoid muscle resulted in a slight impairment of function. Pedicled LD musculocutaneous flaps are useful for covering the defect that results from resection of the deltoid muscle and they contribute additional function to the affected shoulder.