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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Orthop Clin North Am ; 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. Removal of acromial and cora-coid prominences is unnecessary and will further disrupt form as well as reduce leverage for body-powered prostheses. J Bone Joint Surg [Br] ; Replantation may occasionally be considered when the skeletal and neural injuries allow repair or reconstruction, and probably then only in the very amutation patient in whom some useful neurologic and functional recovery is possible.
Guidelines Upcoming Special Issues. The amputation stump itself is of no inherent functional value at these levels because even the ability to grasp or stabilize large objects between the residual limb and thorax will be eliminated.
The clavicle was exposed and divided at the proximal third; care was taken not to tear the underlying vein. Amputwtion available function from a prosthetic replacement decreases as the level of amputation progresses more proximally. 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.
Forequarter amputation for high-grade malignant tumours of the shoulder girdle. You can also find us on social media: Extremity movements were limited exclusively to the hand in a partial matter because of the neuropathic pain. It was suspected to be a secondary metastatic lesion.
Electrically powered prostheses for the adult with an upper limb amputation. Forequarter amputation with fasciocutaneous deltoid flap reconstruction for malignant tumors of the upper extremity. Again treatment options were limited by previous radiation to the axillary forqeuarter. Click for more information about this text.
Natl Med J China. A year-old man was referred for a large, indurated and painful left upper extremity mass that had been increasing in size for five months Figure 1. Above elbow limb replantation: On plain shoulder x-rays, we can see total scapulohumeral articulation lysis, with total destruction of both articulations.
The forequarter amputation was the only alternative to pain management and to increase the overall survival even with distant metastases. In case 2 a limb salvage surgery was attempted for metastic lesion in the upper humerus. Tumor control remains the anputation indication for amputation at this level Reference.
The anterior and posterior skin flaps were used to close the defect primarily. Next, the chest wall attachments of the pectoralis major and minor were divided. 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.
Radical forequarter amputation with hemithoracectomy and free extended forearm flap: The superior and medial borders of the scapula are then freed by division of the levator scapulae, rhomboids, and serratus anterior. Indications, preoperative evaluation, surgical technique, and results.
To obtain wound closure further clavicle and near-complete scapular body excision were necessary. The histopathology diagnosis was fibrosarcoma. The interscapulothoracic amputation forequarter amputation was initially performed for the treatment of gunshot wounds by Ralph Cuming in A Cross-sectional magnetic foreqarter image of the patient with a large left upper extremity mass.
March 18, ; Accepted Date: Although his 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.
Find articles by Eliseo Martinez. Intraoperative view of the divided clavicle, ligated subclavian artery and vein, and ligated brachial plexus. The incisions used are shown in Figure 1. Literally dozens of methods have been described in attempts to alleviate the problems of amputation neuromas.
Next, the chest wall attachments of the pectoralis major and minor were divided. Therefore surgical options were considered; these included above elbow amputation, local excision, and limb sparing wide excision, which would require concomitant total elbow arthroplasty and flap coverage.
Forequarter amputation – Wikipedia
If you would like to receive our newsletter and become a supporter of this well deserving charity please click on the subscription link at the bottom of our website. J Hand Surg ; Nonetheless, early prosthetic fitting does encourage the retention of foorequarter patterns of activity and may result in significantly higher rates of long-term prosthetic use even at these levels. Amputation surgery in amputatioon upper extremity, Orthop Clin North Am ; 3: The authors have no financial interest to declare in relation to the content of this article.
We continued dissecting the humeral artery until the upper limit was reached.