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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Myodesis ensures consistent electromyographic localization that may improve functional control and particularly proportional grasp for wearers of electric prostheses. Natl Med J China. Arterial combat injuries of the upper extremity. Next, the chest wall attachments of the pectoralis major and minor were divided.

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. Division of the pectoralis major and minor muscles anteriorly then allows the limb to fall free.

About Us Contact Us. Amputation stump salvage using a free forearm flap from the amputated part. Support Center Support Center. There is an initial refusal on the part of the patient and even hesitation on the part of the treating surgeon resulting in too few such procedures being carried out even when needed 2.

Forequarter Amputation for Tumours of the Upper Extremity

In the am;utation two decades due to improved chemotherapy and radiotherapy treatments as well as improved surgical technique, there has been an increase in limb preserving surgeries at the expense of radical amputations. 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 follow up.


At surgery, a modified forequarter amputation was performed. Foorequarter forequarter amputation was done. Because this procedure is so deforming, most surgeons and patients do not select this treatment option.

The key symptom was severe pain, which was managed with gabapentin, tramadol, and acetaminophen. Forequarter amputations typically involve removing the entire upper extremity, scapula and part of, or the entire clavicle for palliative, curative purposes [ 1 ] and even as a life-saving procedure in hemodynamically unstable patients [ 2 ].

Eur J Plast Surg. Preservation of the deltoid musculature also facilitates myoelectric control of a prosthesis.

Following the last operative debridement, vacuum assisted closure was utilized. Pre-operative embolization has been described as an important adjunct in neurosurgery, general surgery, urology, head and neck surgery, oral surgery and orthopedics to minimize intraoperative bleeding [ 20 – 23 ] and although complications such as nerve injury [ 24 ], arterial amputaiton [ 25 ], local hemorrhage and ischemic events [ 26 ] and embolization of improper structure have been described, the majority are performed successfully.

He was presented with amputatipn excision versus forequarter amputation as the surgical options. We found it convenient to ligate the bundle under direct vision as a last step after completing the anterior dissection as well. After lengthy discussions with the surgical team, the patient and his family decided to foreqquarter a left forequarter amputation.

The subclavian artery was ligated and cut first, then the subclavian vein was tied and cut to prevent bleeding from the collateral blood supply of the shoulder. In this case, the patient fodequarter intense pain with poor response to opioid analgesics. Currently, the most frequent indications are the presence of malignant tumours of the arm, axilla, shoulder and scapula 2.


Forequarter amputation

Surgical Technique The patient was placed in a left lateral decubitus position to expose the thorax, with the upper extremity freely able to rotate. Since then, numerous modified ampitation, involving concomitant chest wall resection with reconstruction, have been described 2. Surgical, Prosthetic, and Rehabilitation Principles. The large rapidly growing, fungating, ulcerated and foul smelling tumour mass was found to be invading the chest wall Figure 1.

National Center for Biotechnology InformationU. The patient was placed in a right lateral decubitus position to expose the thorax, with the left upper extremity freely able to rotate. Major arteries and veins should be dissected separately and doubly ligated proximally.

Forequarter amputation – Wikipedia

Forequarter amputation is an uncommon procedure that is typically performed to treat aggressive primary soft tissue sarcomas and their recurrences [ 111 – 13 ]. Amputations at the shoulder and at the hip.

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. Forequarter amputation for soft tissue tumors.

Click for more information about this text. Interscapulothoracic forequarter amputation for malignant tumors involving the upper extremity: The clavicle was carefully elevated to expose the subclavian artery, vein, and brachial plexus.

The scapula and upper limb are rotated laterally and displaced anteriorly to allow for identification and control of the neurovascular structures, which are thus placed under tension. Published online Nov Chest wound following debridement secondary to flap necrosis.