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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Extremity movements were limited exclusively to the hand in a partial matter because of the neuropathic pain. Guidelines Upcoming Special Issues. This procedure was originally described in the early 19th century to manage severe, traumatic injuries of the upper extremity 34. 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. Posteriorly, fasciocutaneous skin flaps were developed and all periscapular muscles were released Figure 6.
Indications, preoperative evaluation, surgical technique, and results. J Hand Surg ; Received Jul 28; Accepted Oct 6.
Bone tumours – evaluation and management. At surgery, a modified forequarter amputation was performed.
Arterial combat injuries of the upper extremity. A report of three cases who underwent this procedure at Federal Government Forequarte Hospital, Islamabad is presented.
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 vast majority of traumatic amputations about the shoulder are due to avulsion forces, and the re-establishment of structural con- tinuity is severely limited by the fact that most of these injuries occur through the scapulothoracic articulation rather than through the glenohumeral joint with its greater ligamentous integrity. Forequarter amputation Specialty surgical oncology [ edit on Wikidata ].
In cases of trauma, the lessons of military surgery must be well remembered and primary wound closure performed rarely, if at all. Anderson-Ranberg F, Ebskov B: Following the last operative debridement, vacuum assisted closure was utilized.
In two cases the lesion was a primary bone tumour osteogenic sarcoma and the third one was an advanced metastatic lesion of the upper humerus with soft tissue involvement. Abstract Forequarter interscapulothoracic amputation is a major ablative surgical procedure that was originally described to manage traumatic injuries of the upper extremity.
A forequarter amputation is a radical ablative surgical procedure that includes the entire upper extremity with its shoulder girdle 2.
Forequarter Amputation for Tumours of the Upper Extremity
Despite disfiguring results, forequarter amputation is an effective procedure to cure and palliate tumours of the upper extremities 3. In the anterior technique of Berger Fig 10A Trying to reduce the functional and aesthetic impact of the interscapulothoracic disarticulation, a few authors have described the shoulder defect reconstruction with free composite tissue transference from the elbow of the amputated extremity.
Intraoperative view of the divided clavicle, ligated subclavian artery and vein, and ligated brachial plexus. Palliative forequarter amputation for metastatic carcinoma to the shoulder girdle region: Nevertheless, multiple reconstruction techniques with fasciocutaneous flaps based on the amputated extremity have been described, and they range from small radial flaps to large flaps depending on the remnant defect.
Following this technique the function of the forearm and hand are preserved. Although forequarter amputation was initially described for the treatment of traumatic injuries, it is now more commonly used in managing malignant tumours of the upper extremity. Later, inDixie Crosby described its use for cancer treatment. There is still a room for an extensive procedure like forequarter amputation for malignancies around the shoulder when limb salvage surgery is either inappropriate or impossible for local control of disease.
Forequarter amputation – Wikipedia
Forequarter amputation with fasciocutaneous deltoid flap reconstruction for malignant tumors of the upper extremity. Anterior dissection is completed by release of the latissimus dorsi from forequartfr humeral insertion.
The clavicle is exposed subperiosteally and divided.
Radical forequarter amputation with hemithoracectomy and free amputaton forearm flap: The surgical technique for the present case of forequarter amputation was originally described by Berger in 1. Limb-sparing surgery, preceded and followed by effective chemotherapy with or without radiation therapy, has replaced the radical surgical approach for treating limb sarcomas in most cases 5.
Your hand sweeps behind scapula. At the time of closure, flap edges appeared viable with adequate bleeding. Amputations of upper extremity, in Crenshaw AH ed: Amputations at the shoulder and at the hip. The indications include but are not limited to: Unfortunately forequartsr patient had a fall several weeks postoperatively and this caused a wound dehiscence along the flap margin. The histopathology diagnosis was fibrosarcoma.
Overzealous distal traction may produce interstitial failure of the neural elements and formation of a more proximal symptomatic amputatiion in continuity. Forequarter amputation; Soft tissue sarcoma; Preoperative embolization; Squamous cell carcinoma; Recurrence; Malignancy.
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.