Forequarter amputation (FQA) is a surgical treatment of tumors in the upper extremity and shoulder girdle that infiltrate the neurovascular. Forequarter or inter scapulothoracic amputation is an uncommonly performed operation for malignant tumours involving the proximal end of humerus and the. Forequarter amputation combined with chest wall resection is a rarely performed procedure. Six patients were treated for advanced malignancies with this.
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Initially, it was used as salvage replantation, when a replantation was unfavorable because of a high proximal level injury, severe crushing, and avulsion injury. Divide pec minor insertion and very imp divide origin and get deep to serrates anterior.
Bone tumours – evaluation and management.
10A: Shoulder Disarticulation and Forequarter Amputation | O&P Virtual Library
Author information Article notes Copyright and License information Disclaimer. Can J Plast Surg. Electrically powered prostheses for the adult with an upper limb amputation. Following the last operative debridement, vacuum assisted closure was utilized. The final outcome is shown at six weeks after the surgery. The work cannot be changed in any way or used commercially. Recent advances in limb-sparing techniques have reduced the number of major amputations performed for tumours of the upper extremity 1.
Intraoperative view of the components of the flap, including the humeral artery and the cephalic vein. The incisions used are shown in Figure 1.
Soft tissue dissection was at the fascial level over the forequwrter major.
The available function from a prosthetic replacement decreases as the level of amputation progresses more proximally. Such nonconventional use of otherwise discarded portions of the amputated limb should always be considered.
After a multidisciplinary discussion involving medical and radiation oncology, it was decided that the patient required surgical resection before radiation. Forequaarter of the affected extremity was considered for many years to be the standard of care for treating and curing patients with bone and soft tissue sarcomas of the limbs.
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Open in a separate window. After lengthy discussions with the surgical team, the foeequarter and his family decided to undergo a left forequarter amputation.
X-rays revealed an osteodestructive lesion of the upper end of right humerus with soft tissue extension. In conclusion, we assure that the flap based in the humeral artery can safely irrigate the fasciocutaneous amputaton all the way from midpoint in the arm to the midpalmar region, making it possible to harvest larger flaps for interscapulothoracic amputation reconstruction.
At surgery it was evident that ampuhation muscle and overlying skin had necrosed, likely due to the combination of previous radiation and embolization. Limb-sparing surgery, preceded and followed by effective chemotherapy with or without radiation therapy, has replaced the radical surgical approach for treating limb sarcomas in most cases 5.
Although amputation through the surgical neck of the humerus is functionally equivalent to shoulder disarticulation, maintenance of shoulder width and axillary contour by the former procedure is a distinct cosmetic advantage. The authors have no financial amphtation to declare in relation to the content of this article.
Surgical Principles John A. Later, inDixie Crosby described its use for cancer treatment. The goal amputatoin forequarter amputation also known as shoulder girdle amputation is to radically remove the bones and soft tissue of the upper extremities, including the scapula 1.
Bull Hosp Jt Dis. Despite the superficial osseous structures of the shoulder girdle and chest wall, split-thickness skin grafting of these areas can often be tolerated beneath a prosthetic socket. In shoulder disarticulation the articular cartilage on the face of the glenoid is left undisturbed. Therefore surgical options were considered; these included above elbow amputation, local excision, and limb sparing wide excision, which would require concomitant total elbow arthroplasty and flap coverage.
A custom humeral prosthesis 6 or an inter positional metallic device 7 may be implanted for reconstruction.
Our cases presented at an advanced stage. Major upper extremity amputation ampuration Denmark. Case 1 A female of 30 reported with a slowly increasing painful mass in the right upper arm for the last three months.
Divide large nerve trunks around these as prox as poses.