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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10A: Shoulder Disarticulation and Forequarter Amputation | O&P Virtual Library
With the advent of limb-sparing techniques, primary forequarter amputation is performed less frequently, but remains a powerful surgical option in managing malignant tumours of the upper extremity; therefore, surgeons should be familiar with this procedure. No cases from extended humeral-radial artery forearm flap with fasciocutaneous extension from the middle arm to the middle hand were found. We present a year-old woman with a previous history of simple mastectomy 8 years back secondary to a phyllodes tumor in her right breast.
Unfortunately, over the next two weeks his flap margins began to show ischemic changes and revision surgery was required for flap debridement.
Improved shoulder contour following forequarter amputation with an osteomyocutaneous free flap from the amputated extremity: Forequarter amputation; Soft tissue sarcoma; Preoperative embolization; Squamous cell carcinoma; Recurrence; Malignancy. The clavicle was carefully elevated to expose the subclavian artery, vein and brachial plexus.
Surgical Principles John A. Pre-operative subclavian and axillary artery angiogram with subclavian artery embolization was performed in order to help with intraoperative hemostasis.
Early and immediate post-surgical prosthetic fitting. Then come onto chest wall immed anterior and divide Pec maj origin from remaining clav. So all three patients had to undergo such an extensive procedure.
Despite disfiguring results, forequarter amputation is an effective procedure to cure and palliate tumours of the upper amputationn 3. The upper extremity amputee: Immediate, early and late postsurgical management of upper limb amputation. The tumour was 30 cm in diameter.
Major amputations done with palliative intent in the treatment of local bony complications associated with advanced cancer. The patient adamantly rejected amputation and therefore elected to undergo re-excision of the mass, total elbow replacement and latissimus dorsi myocutaneous rotation flap.
In consultation with medical and radiation oncologists, it was decided that further surgery chest wall excision was too risky and unwarranted in this circumstance and therefore he agreed to local chest wall radiation in hopes of controlling local tumour growth.
Amputation has also been advocated as a palliative procedure for symptomatic, locally advanced disease that has already failed to respond to radiation therapy, chemotherapy and limited surgery 7. The upper limit was the midpoint of the arm, 10 cm from the lower limit of the tumor. After lengthy discussions with the surgical team, the patient and his family decided to undergo a left forequarter amputation. Funding is foerquarter needed for new projects and to update and refurbish existing facilities.
Reconstruction flrequarter the chest wall following extended interescapulothoracic amputation and chest wall resection. The anterior approach was used with an elliptical incision from the midsternal line to the 10th intercostal space, in the anterior lower border to the entire length of the scapula trough the midaxillary line, taking all the shoulder to the medial border of the supraclavicular triangle.
An anterior approach was used for forequarfer forequarter amputation.
Sufficient sensate skin with adequate subcutaneous tissue for padding and normal vascularity is seldom a problem at this level, save in the traumatic amputee. 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.
Forequarter Amputation for Tumours of the Upper Extremity
He developed superficial wound infection managed successfully with appropriate antibiotics. Please review our forequartr policy. 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. Two months following successful skin graft healing, a new and rapidly growing chest wall recurrence became evident Figure fodequarter.
Forequarter amputation is an uncommon procedure that is typically performed to treat aggressive primary soft tissue sarcomas and their recurrences [ 111 – 13 ].
Orthop Clin North Am ; 8: However major upper limb amputations remain a necessary treatment for aggressive or recurrent malignancies when limb preserving techniques have been exhausted. 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.
March 18, ; Accepted Amutation Initially, it was used as salvage replantation, when a replantation was unfavorable because of a foreuqarter proximal level injury, severe crushing, and avulsion injury.
Vasa nervorum that are large enough to be evident are best controlled by gentle dissection from the surface of the nerve and bipolar electrocoagulation.
After about eight-months she came back as the weight of the arm was becoming unbearable due aamputation further increase in size. Acceptance rates of conventional body-powered prostheses therefore fall considerably for shoulder-level amputees. 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.
Biopsy confirmed forequaeter differentiated invasive squamous cell carcinoma with positive margins.
A forequarter amputation is a radical ablative surgical procedure that includes the entire upper extremity with its shoulder girdle 2. Forequarter or inter scapulothoracic amputation is an uncommonly performed forequartr for malignant tumours involving the proximal end of humerus and the shoulder. Much of the material in this text has been updated and published in Atlas of Amputations and Limb Deficiencies: Anputation Forequarter amputation is a mutilating procedure which imparts a grave psychogenic trauma to the patient.