Scapulectomy for tumor. A, Position of patient and incision for surgery for tumor located in center of scapula (dark spot). Arm should be draped completely free so that it can be mobile to facilitate excision of muscular attachments. B, Scapular muscles exposed after raising skin flaps. Trapezius muscle is resected at scapular spine as shown. Green dashed line indicates site of excision of deltoid muscle. C, Trapezius and deltoid muscles have been reflected, and latissimus dorsi muscle has been retracted distally. Assistant is pulling tip of scapula laterally (arrow). This maneuver facilitates resection of muscles attached to vertebral border of scapula. D, Inset, Palpation of axillary contents, which need to be retracted out of operative field. Main illustration shows tip of scapula pulled inferomedially and muscles detached as shown. Green broken line indicates line of section of supraspinatus, infraspinatus, and serratus anterior muscles. E₁, Section of scapular spine at base of acromion with osteotome. After subscapularis muscle is cut under guidance of operator’s finger, Gigli saw is passed around neck of scapula, which is sectioned (E₂). E₃, Excised scapula with intact shoulder joint. F, Closure and reattachment of muscles. Deltoid and trapezius are sutured to each other and to acromion process. Teres major and minor muscles are attached to thoracic wall.(Redrawn from Das Gupta TK: Scapulectomy: indications and technique, Surgery 67:601, 1970.) SEE TECHNIQUE 24.2.