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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About Us Contact Us. Hidalgo pte, col. Case Report Open Access. Skin and muscle flaps are large, and wound drainage should be used routinely.
Forequarter amputation is usually performed when a limb-sparing operation is not possible, either following a severe injury to the upper limb or in managing primary soft tissue or bone tumours of the upper extremities. Campbell’s operative orthopaedics, 7th ed.
Philadelphia, JB Lippincott, He experienced only occasional phantom limb pain, which is a common sequela of forequarter amputation. Clin Orthop ; Eur J Plast Surg. Unfortunately, over the next two weeks his flap margins began to show ischemic changes and forequarterr surgery was required for flap debridement. In conclusion, we assure that the flap based in the humeral artery can safely irrigate the fasciocutaneous tissue all the way from midpoint in the arm to the midpalmar region, making it possible to harvest larger flaps for interscapulothoracic amputation reconstruction.
Treatment of painful neuromas. The first oncological forequarter amputation was reportedly performed by Dixie Crosby in for a case of osteosarcoma.
The surgical technique for the present case of forequarter amputation was originally described by Berger in 1.
Bone scan revealed increased uptake in the soft tissues of the upper limb including the shoulder joint area. A custom humeral prosthesis 6 or an inter positional metallic device 7 may be implanted for reconstruction.
Research articles conducted on animals, will not be considered ampktation processing or publication in the JPMA. After a multidisciplinary discussion involving medical and radiation oncology, it was decided that the patient required surgical resection before radiation.
Forequarter amputation is amputation of the foorequarterscapula and clavicle. In case 2 a limb salvage surgery was attempted for metastic lesion in the upper humerus.
The radiographs and biopsy revealed osteogenic sarcoma of the upper end of humerus with soft tissue involvement. Radical forequarter amputation with hemithoracectomy and free extended forearm flap: Agri and Aquaculture Journals Dr. 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.
Although amputation through the surgical neck of the humerus is functionally equivalent to shoulder disarticulation, maintenance of shoulder width and axillary contour by the former procedure is a distinct cosmetic advantage.
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10A: Shoulder Disarticulation and Forequarter Amputation | O&P Virtual Library
Suggested skin incisions are depicted in Fig 10A The goal of forequarter amputation also known as shoulder girdle amputation is to forequartwr remove the bones and soft tissue of the upper extremities, including the scapula 1. Ultimately wound coverage was obtained via vacuum assisted closure Figure 6 followed by split thickness skin grafting 2 weeks later. Find articles by Carlos Gonzalez.
Forequarter amputation for high-grade malignant tumours of the shoulder girdle. Amputation stump salvage using amputatoin free forearm flap from the amputated part. He subsequently underwent postoperative axillary radiation. Forequarter interscapulothoracic amputation is a major ablative surgical procedure that was originally described to manage traumatic injuries of the upper extremity.
The superior and medial borders of the scapula are then freed by division of the levator scapulae, rhomboids, and serratus anterior.
Forequarter Amputation for Tumours of the Upper Extremity
Find articles by Juan Carlos Tamez. Surgical pathology confirmed the specimen to be malignant fibrous histiocytoma with negative nodes and clear margins.
She was referred to the radiotherapy institute where she received cytotoxic drug therapy. Branches of the brachial plexus were ligated and divided proximally Figure 5. The area of the chest left exposed is then normally covered with a split-thickness skin graft. The tumour has significantly impaired the functional status of the extremity to complete disuse or produces severe pain 8.
However, major upper limb amputations remain a necessary treatment for aggressive or recurrent malignancies when limb preserving techniques have been exhausted [ 1 ].
J Bone Joint Surg Br. Currently, it is most commonly used in the treatment of malignant tumours of the arm. After about eight-months she came back as the weight of the arm was becoming unbearable due to further increase in size. Although foresuarter case is likely palliative rather than curative and his 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.
The rhomboid muscles, trapezius, levator scapulae and latissimus dorsi are transected. We present a year-old woman with a solid slow growing tumor in her right shoulder of 15 amputatiln 20 cm in diameter. Forequarter amputation for soft tissue tumors.
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.
March 18, ; Accepted Date: Interscapulothoracic forequarter amputation for malignant tumors involving the upper extremity: J Bone Joint Surg Br.