A partial scapulectomy (Type IIA) was performed in all patients as previously described [14]. The resection of all involved soft tissues was extralesional, with a 2 to 5 cm margin. Thus, according to the extent of the lesion in these patients, little of the deltoid, latissimus dorsi, or biceps brachii were resected due to partial tumor invasion. The Blasticidin S ic50 rotator cuff, particularly the supraspinatus, infraspinatus,

and subscapularis, were excised, similar to the external rotator muscles. Most of the affected muscles surrounding the thoracoscapula required en bloc excision with the tumor. Combretastatin A4 ic50 The suprascapular nerve and blood vessel bundle required removal in only one patient (#1). The affected muscles were commonly this website characterized intraoperatively as swollen, necrotic, and deficient in elasticity/contractibility. Following excision of affected soft tissues, resection of the acromion base and coracoid process (with preservation of the tips) was performed in all patients. Subsequently, the distal end of the clavicle was resected in patient #2 and the normal glenoid (in patients #2, 3, 6, and 7) was osteomized longitudinally at least 1 cm medial to the glenoid edge in sequence while preserving the glenoid articular capsule and surface (in the glenoid-saved group). Alternatively, for the patients with an involved glenoid (#1, 4, and 5), the

glenoid was resected together with the articular surface through an additional incision of the capsule (i.e., the glenoid-resected group). Finally, the affected scapula bodies

were resected (in patients #1, 2, 3, 5, and 6) based on analysis of the intraoperative frozen sections that were taken to determine the surgical margins. A wide resection and safe surgical margin was selected for all patients. Bone and soft tissue management The articular capsule and muscles, particularly the abductors, were reconstructed in sequence following bony reconstruction. The fresh-frozen (-80°C) scapular allografts were provided by the bone bank at the authors’ medical institution. Size-matched scapula allografts were placed to fit the bone defect, with a posterior glenoid tilt angle of 8° to 12° and a downward slope angle of 4° of the glenoid fossa. Fixtures used Immune system for the glenoid-saved allografts depended on the thickness of the remaining glenoid. When the glenoid thickness exceeded 1 cm, the allograft was fixed proximal to the lateral border of the scapula. For patients with a glenoid thickness of less than 1 cm, the articular capsule was instead sutured through holes created at the glenoid edge. The residual scapula were fixed to the glenoid-resected allografts with plates and screws and the articular capsule was sutured circumferentially via holes created in the allograft’s glenoid edge.