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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The humeral vein was anastomosed end-to-side to the subclavian vein. If you would like to receive our newsletter and become a supporter of this well deserving charity please click on the subscription amputarion at the bottom of our website. A search for the primary revealed a mass in the left renal area. A Anterior view of the patient with the left upper extremity mass causing displacement of the arm at rest.
amputatiom Branches of the brachial plexus were ligated and divided proximally. Foreqharter Jul 28; Accepted Oct 6. The indications include but are not limited to: Forequaretr he received radiotherapy arid chemotherapy. Postoperatively she developed; excessive upward lift of the breast which was corrected with plastic repair.
Pre-operative embolization for the purpose of controlling intra-operative and post-operative blood loss is a described technique [ 9 ] and its use in conjunction with sarcoma resection has been reported [ 10 ] however its use in forequarter amputations has not been described. Amputation surgery in the upper extremity, Orthop Clin North Am ; 3: 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.
A racquet incision was utilized with early excision of the humerus. He was seen again after a year and a half with painful progressive swelling of the whole upper arm with loss of function of two months duration.
South Med J ; Cautery should not be relied upon for their control. Your hand sweeps behind scapula.
Because this procedure is so deforming, most surgeons and patients do not select this treatment option. Divide all muscles amlutation to scapula.
Intraoperative view of the components of the flap, including the humeral artery and the cephalic vein. In the case of forequarter amputation, any remaining musculature, such as the pectoralis major, latissimus dorsi, and trapezius, should be sutured together to form additional padding and contour over the chest wall.
Preoperative consultation by vascular surgery advised preoperative embolization. The upper limit was the midpoint of the arm, 10 cm from the lower limit of the tumor.
The incisions used are shown in Figure 1. J Bone Joint Surg Br. The details of surgical technique are well delineated in the standard textbooks and monographs on amputation.
Abstract Forequarter interscapulothoracic amputation is a major ablative surgical procedure that was originally described to manage traumatic injuries of the upper extremity. Home Publications Conferences Register Contact. Although his case is likely palliative rather than curative and forequaarter postoperative course will likely involve local recurrence, at last follow up 8 months post-operativehis pain was well controlled and he was able to participate in daily life activities.
Myodesis ensures consistent electromyographic localization that may improve functional control and particularly proportional grasp for wearers of electric prostheses. The radiographs and biopsy revealed osteogenic sarcoma of the upper end of humerus with soft tissue involvement. Click for more information about this text. The extended radial forearm flap.
Forequarter amputation for soft tissue tumors. amputwtion
Nonetheless, early prosthetic fitting does encourage the retention of two-handed patterns of activity and may result in significantly higher rates of long-term prosthetic use even at these levels. Tension free closure was performed. Can J Plast Surg. Forequarter amputation, Interscapulothoracic, Sarcoma, Shoulder girdle, Upper limb.
Unfortunately, in our patient the skin flap and underlying muscle did not survive. The purpose of the present article is to familiarize surgeons with the indications for and surgical technique of this uncommon but valuable surgical procedure through presentation of a classic case report of forequarter amputation for a forequartee tumour of the upper extremity. The charity was founded over 30 years ago after our founder Trustee, Val Jourdan visited the region as a physiotherapist.
Initially she refused surgery. At surgery it was evident that deltoid muscle and overlying skin had necrosed, likely due to the combination of previous radiation and embolization.
10A: Shoulder Disarticulation and Forequarter Amputation | O&P Virtual Library
The clavicle is exposed subperiosteally and divided. Is amputation necessary for sarcomas? Once in the brachioradialis muscle, the radial artery of the forearm flap was dissected as previously described Figs. During forequarter amputation, osteotomy of the clavicle should be performed at the lateral margin of the sternocleidomastoid insertion whenever possible in order to preserve contour of the neck. Forequarter amputations typically involve removing amputxtion 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 ].
There is still a room for forequarfer extensive procedure like forequarter amputation for malignancies around the shoulder when limb salvage surgery is either inappropriate or impossible for local control of disease. About Us Contact Us. The age and health of patient allows for a major surgical procedure, but not a series of reconstructive procedures. Stop muscle bleeding with count suture.
Published by Wolters Kluwer Health, Inc. Currently, the most frequent indications are the presence of malignant tumours of the arm, axilla, shoulder and scapula 2.