The Tikhoff-Linberg procedure was originally described more than 80 years ago as a limb-sparing surgical option for malignancies involving the shoulder girdle. However, involvement of the chest wall was a contraindication, consigning patients to either amputation or shoulder disarticulation. With the addition of prosthetic and autologous tissue reconstruction of the chest wall, this procedure is a viable option for an extended group of patients. The modified procedure offers an excellent functional result, leaving the patient with a fully functional arm and hand.