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.

Author: Gokree Arashile
Country: Sao Tome and Principe
Language: English (Spanish)
Genre: Environment
Published (Last): 4 March 2005
Pages: 244
PDF File Size: 1.98 Mb
ePub File Size: 9.85 Mb
ISBN: 604-9-35261-443-3
Downloads: 18408
Price: Free* [*Free Regsitration Required]
Uploader: Nacage

Following the last operative debridement, vacuum assisted closure was utilized. Bull Hosp Jt Dis.

Forequarter amputation

The key symptom was severe pain, which was managed with gabapentin, tramadol, and acetaminophen. Once the whole arm was detached form the thorax, a second surgical team made the dissection of the extended humeral-radial middle arm and forearm flap. To find out more about ABCD,the work we do and how our funding is spent go to www.

Fogequarter of Limb Prosthetics: Telephonefaxe-mail moc.

Forequarter Amputation for Tumours of the Upper Extremity

Palliative forequarter amputation for metastatic carcinoma to the shoulder girdle region: We were able to utilize the posterior half of deltoid muscle and overlying skin for local flap closure and a tension free closure was obtained Figure 4. The clavicle was exposed and divided at the proximal third; care was taken not to tear the underlying vein. The indications include but are not limited to: One amputatoin before admission he developed in-ability to move the arm with a deformity in the upper part.

Acta Orthop Scand ; 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.


Forearm free skin flap transplantation. InPaul Berger published a classic description of an anterior approach to forequarter amputation 1.

Forequarter amputation – Wikipedia

In this case, the patient referred intense pain with poor response to opioid analgesics. We present the case of a patient with recurrent upper extremity sarcoma and squamous cell carcinoma in a previously irradiated tissue bed who underwent a forequarter amputation with flap reconstruction after undergoing pre-operative embolization.

Surgical, Prosthetic, and Rehabilitation Principles. B Coronal magnetic resonance image of the same patient. The tumour was adherent to the chest wall. Functional prosthetic rehabilitation is both difficult and expensive.

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 6. None of the various physical and chemical methods of treating the nerve stump seems to have an advantage over simple distal forequarteer on the nerve, sharp division, and its retraction under proximal cover away from the end of the residual limb and the cutaneous amptuation.

He was left with a gangrenous stump and had a few days to live. Once in the brachioradialis muscle, the radial artery of the forearm flap was dissected as previously described Figs.

Is amputation necessary for sarcomas? 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.

Clin Orthop ; Techniques of limb salvage surgery and multimodality therapy like radiation, local and systemic chemotherapy are also being done for these patients 3. Stop muscle bleeding with count suture. Skin and muscle flaps are large, and wound drainage should be used routinely.


A classic case report of forequarter amputation, with emphasis on indications and surgical techniques, is presented. Divide all muscles attached to scapula.

In the last 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. We continued dissecting the humeral artery until the upper limit was reached. The details of surgical technique are well delineated in the standard textbooks and monographs on amputation.

We suspected a germline cancer mutation such as Li- Fraumeni syndrome and therefore consulted medical genetics for appropriate testing. A complete metastatic evaluation, including magnetic resonance imaging and computed tomography, only revealed a large left upper extremity soft tissue mass surrounding the axillary vessels Figure 2.

The limb is then allowed to fall posteriorly and dissection completed by release of the periscapular musculature from the superior and medial borders of the bone, including the trapezius, omohyoid, levator scapulae, rhomboids, and serratus anterior. The extended radial forearm flap. Initially she refused surgery. He therefore underwent urgent flap revision utilizing a radial forearm fasciocutaneous rotation flap, which was initially successful.

J Reconstr Microsurg ; 3: First, a midline incision in the back of the forearm extended to the lower third of the arm was performed to dissect the fasciocutaneous flap from the underlying muscles. Forequarter amputation is amputation of the armscapula and clavicle.