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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Forequarter Amputation for Tumours of the Upper Extremity
Intraoperative view of the divided clavicle, ligated subclavian artery and vein, and ligated brachial plexus. Cautery should not be relied upon for their control.
Orthop Muscul Syst 4: Six months later, he noticed an ulcerating and foul smelling mass in his left axilla that was biopsied and pathology confirmed a new squamous cell carcinoma. However, major upper limb amputations remain a necessary treatment for aggressive or recurrent malignancies when limb preserving techniques have been exhausted [ 1 ]. Funding is constantly needed for new projects and to update and refurbish existing facilities. Major ablative procedures in orthopaedic surgery.
This includes collateral vessels, which in this region may be quite large. Resection and immediate reconstruction with a free radial forearm flap extended from the distal third of the arm to the midpalmar region, taking the humeral artery and the cephalic vein as a main peddicle. Case 1 A female of 30 reported with a slowly increasing painful ampuation in the right upper arm for the last three months.
Anterior dissection is completed by release of the latissimus dorsi from its humeral insertion. Next, the chest wall attachments forequsrter the pectoralis major and minor were divided. A Cross-sectional magnetic resonance image of the patient with a large left upper extremity mass.
Large cavitary, foul smelling lesion in the anterior axilla.
None of the various physical and chemical methods of treating the nerve stump seems to have an advantage over simple distal traction on the nerve, sharp division, and its retraction under proximal cover away from the end of the residual limb and the cutaneous scar. The histopathology diagnosis was fibrosarcoma.
Once in the brachioradialis muscle, the radial artery of the forearm flap was dissected as previously described Figs. J Plast Reconstr Aest Surg. A forequarter amputation was done. This is a complex case underlining the importance of clear communication between the surgical team, patient and family, balancing operative risks and benefits as well as patient expectations, careful pre-operative planning and frequent post-operative amputatioj up.
Orthop Clin North Am ; Support Center Support Ampputation. Although the first forequarter amputation was performed in to treat a gunshot wound, currently the majority are performed to treat primary or recurrent soft tissue sarcomas of the proximal humerus or axilla.
Published by Wolters Kluwer Health, Inc. Next, the chest wall attachments of the pectoralis major and minor were divided. Removal of acromial and cora-coid prominences is unnecessary and will further disrupt form as well as reduce leverage for body-powered prostheses. Received Jul 28; Accepted Oct 6. Find articles by Carlos Gonzalez. He therefore underwent urgent flap revision utilizing a radial forearm fasciocutaneous foreuqarter flap, which was initially successful.
In this way, the aesthetic appearance improves considerably; however, in our case, the clavicle was totally resected, so we lack an adequate anchorage to perform such reconstruction.
This procedure is usually well tolerated in carefully selected patients who are suffering intractable pain from a dysfunctional limb. The superior and medial borders of the scapula are then freed by division of the levator scapulae, rhomboids, and serratus anterior.
10A: Shoulder Disarticulation and Forequarter Amputation | O&P Virtual Library
After a multidisciplinary discussion involving medical and radiation oncology, it was decided that the patient required surgical resection before radiation. The inferior apex was made at the midaxillary line and continued posteriosuperiorly over the entire length of the scapula to join the superior apical incision. Recent advances in limb-sparing techniques have reduced the number of major amputations performed for tumours of the upper extremity 1.
Amputation 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. Eur J Plast Surg. In case 2 a limb salvage surgery was attempted for metastic lesion in the upper humerus. Campbell’s operative orthopaedics, 7th ed. Forequarter amputation Specialty surgical oncology [ edit on Wikidata ].
No cases from extended humeral-radial artery forearm forequagter with fasciocutaneous extension from the middle arm to the middle hand were found. However, it is a relatively safe and reliable procedure for alleviating pain and improving quality of life for selected patients with unresectable tumours of the upper extremity. InPaul Berger published a classic description of an anterior approach to forequarter amputation 1.
Forequarted limb salvage using a free radial forearm flap. Amputation surgery is not an abandoned idea today, but its application tends to be limited to cases of advanced disease that are unmanageable by a less radical approach or in patients with recurrent tumours after conservative treatment in whom limb salvage is not feasible anymore forequatter. The first forequarter amputation was performed in to treat a gunshot wound [ 3 ] while the first forequarter amputation to treat an upper extremity malignancy was performed in [ 4 ].
The details of surgical technique are well delineated in the standard textbooks and monographs on amputation. Research articles conducted on animals, will not be considered for processing or publication in the JPMA.
J Hand Surg ; To obtain wound closure further clavicle and near-complete scapular body excision were necessary. He underwent forequarter amputation via an anterior approach Figure 4.
The extended radial forearm flap. However, we did not find any case in which the humeral artery was used all the way to the midpalmar region for covering the defect. But such salvage procedures can only be undertaken in well-confined forequqrter early lesions 2,3,6.