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by dr Zico Paradigma - Thursday, 5 July 2018, 12:31 PM
Case Report:
The Tikhoff-Linberg Procedure in the
Treatment of Alveolar Rhabdomyosarcoma of Scapula
Syarifah Debi Mulya*, Rhyan Darma Saputra**
*Resident of General Surgery, faculty of medicine, Sebelas Maret University
**Staff of Orthopaedi and Traumatology, faculty of medicine, Sebelas Maret University
Dr. Moewardi General Hospital

Introduction: Limb-Sparing Resection of the upper extremity is challenging. For some patients an amputation or exarticulation is the only final surgical treatment with either a curative or palliative intent. However, in selected sarcomas of the shoulder girdle a radical en-bloc upper humeral interscapulothoracic or Tikhoff-Linberg resection instead of a forequarter amputation, can be performed as a limb-salvage procedure.

Method: descriptive study one case, female 46 years old complaint of pain lump at her left shoulder that getting bigger for 6 month. Patient had preoperative staging with radiographs and magnetic resonance imaging (MRI) of the shoulder, bone scan, followed by core biopsy for histologic diagnosis of the tumors. We decided to performed Limb Salvage Surgery with an extraarticular resection type III of Tikhoff-Linberg Procedure. Tumor material, soft tissue and bone around the tumor was sent to pathology laboratory for histopatholigical diagnosis.

Result : We have successfully performed surgery on the patient. Clinical result quite satisfactory after the surgery. Altough has significant loss of shoulder Range of Movement (RoM), patient still able to move the elbow and wrist in full flexion-extension, and also for supination-pronation. Patient has a good hand function. The Dash Score before operation is 100 when getting better after operation with Dash score 80.83. There was no sensoric loss after the surgery. Histopatological finding was Alveolar Rhabdomyosarcoma of Scapula with the clear margin was achieved.
Kesimpulan: Penarikan bahu ekstra-artikular Tikhoff-Linberg adalah perawatan bedah yang layak untuk memisahkan amputasi dan disartikulasi bahu untuk tumor jinak ganas dan ganas di bahu. Reseksi bahu ekstra-artikular memungkinkan fungsi tangan dan lengan bawah hampir normal, dengan fungsi siku yang wajar. Terlepas dari kerumitannya, reseksi ini dapat dilakukan pada sekitar 95% pasien dengan sarkoma derajat rendah. Evaluasi Jangka Panjang diperlukan untuk pasien kesehatan umum, aktivitas harian dan tentu saja penyakit rekuren.

Kata kunci: Bedah Limbal, Prosedur Tikhoff-Linberg, Alveolar Rhabdomyosarcoma, Skor DASH