Forequarter amputation an overview sciencedirect topics. Nelson md, faaos, carolyn taliaferro blauvelt, in a manual of. Zachary ls, gottlieb lj, simon m, ferguson mk, calkins e. Forequarter amputations typically involve removing the entire upper extremity. Forequarter amputation and immediate reconstruction with a. Atlas of advanced operative surgery 1st edition pdf.
The use of free fillet flaps for reconstruction after forequarter and traumatic upper extremity amputations is illustrated here in a case report. Because of weight and complexity of the prosthesis most amputees dont wear a full prosthesis for this level of amputation. Parsons 3rdcircumferential forearm fasciocutaneous free flap reconstruction of forequarter amputationchest. Pdf forequarter amputation is performed for highgrade malignant tumours in.
This report provides evidence that a complete hemithoracectomy, pneumonectomy, and forequarter amputation can be safely performed for selective tumors involving the shoulder region with extensive chest wall invasion. Shoulder disarticulation and forequarter amputation. Six patients were treated for advanced malignancies with this operation in our institution since 1993. A free fillet flap of the amputated arm and an additional local epaulette flap were used to. A forequarter amputation is a radical ablative surgical procedure that includes the entire upper extremity with its shoulder girdle. Summary of responses on forequarter amputation opedge.
Amputation amputation is defined as removal of the limb through a part of the bone disarticulation. This new resource picks up where other surgical references leave off, providing highly visual, stepbystep guidance on more than 100 advanced and complex procedures in both general and subspecialty areas. Different measures can be taken to prevent the need for a forequarter amputation in dogs. We present a 53yearold woman with a solid slow growing tumor in her right shoulder of 15 x 20 cm in diameter.
Free fillet flap application to cover forequarter or. Forequarter amputation in dogs procedure, efficacy. A forequarter amputation is less commonly performed today than in the past. Amputees had slower freewalking velocity, higher oxygen consumption per meter. This is the most current surgical text describing and illustrating. Technique of forequarter interscapulothoracic amputation. Shoulder disarticulation or forequarter amputation. Improved shoulder contour following forequarter amputation with an. Most are treated with a combination of wide local excision and radiotherapy, but a small numberincluding proximal, large, highgrade, or recurrent tumours, or those involving major neurovascular structuresnecessitate major amputation including forequarter or hindquarter. The first oncological forequarter amputation was reportedly performed by dixie crosby in 1836 for a case of osteosarcoma.
Resection and immediate reconstruction with a free radial forearm flap extended from the distal third of the arm to the midpalmar region, taking the. Radical forequarter amputation with hemithoracectomy and free. The journal of neurological and orthopaedic medicine and surgery april 2016 1 forequarter amputation for primary malignant tumours of proximal upper limb. Forequarter definition of forequarter by the free dictionary. Improved technique for radical transthoracic forequarter amputation. Forequarter amputation entails en bloc removal of the upper extremity together with the scapula and the lateral aspect of the clavicle. In shoulder disarticulation the articular cartilage on.
This latter bone is mobilized and is used, along with the transposition of the lower ribs, to stabilize the chest wall. Forequarter amputation synonyms, forequarter amputation. Pdf forequarter amputation and immediate reconstruction. Forequarter amputation entails surgical removal of the entire upper extremity, scapula, and clavicle.
Uncontrollable pain, lymphedema, loss of function of the affected limb and, in some patients, localized ulceration of the tumor at the time of presentation, provided the indication for the. One armed wonder fitness guru born without arm shares inspirational life story. Forequarter amputation is a radical operation performed for treatment of malignant neoplasms of the shoulder girdle not amenable to limb salvage. Amputee rehabilitation lynn cunningham, pt, dpt helena lax, md mark nielsen, cp, atc. In both curative and palliative settings, fqa can serve as an effective oncological treatment.
Vascular control for a forequarter amputation of a massive. This can be done by going on daily walks with your pet, which can. Forequarter amputation for malignancy rickelt 2009. Improved shoulder contour following forequarter amputation. Forequarter amputation and immediate reconstruction with a free extended.
Taha, md, fibms department of thoracic and cardiovascular surgery school of medicine university of. Our personal experience of ten cases has achieved a. Amputation for softtissue sarcoma the lancet oncology. In the forequarter amputation the scapula and clavicle are also removed. Because of the advances in regional and systemic therapies, radical amputation procedures are rarely performed. During forequarter amputation, osteotomy of the clavicle should be performed at the lateral margin of the sternocleidomastoid insertion whenever possible in order to preserve contour of the neck. See forequarter amputation, hindquarter amputation. The forequarter amputation also makes the body appear asymmetrical as the shoulder width is reduced significantly. Currently, it is most commonly used in the treatment of malignant tumours of the arm. It is usually performed as a last resort to remove a cancer, but decreasingly so as limbsparing operations improve surgical technique. Radical forequarter amputation with hemithoracectomy and. The entire forequarter is removed after ligation and transection of the brachial plexus and subclavian.
The interscapulothoracic amputation forequarter amputation was initially performed for the treatment of gunshot wounds by ralph cuming in 1808. Forequarter amputation fqa is a surgical treatment of tumors in the upper extremity and shoulder girdle that infiltrate the neurovascular bundles. Forequarter amputation is amputation of the arm, scapula and clavicle. A free powerpoint ppt presentation displayed as a flash slide show on id. A forequarter amputation is a radical ablative surgical procedure that includes the entire upper extremity with its shoulder.
Forequarter amputation for tumours of the upper extremity pages with reference to book, from 240 to 242 mohammed amir, mohammed abdhoo malik, inamul haq shami department of surgery, federal government services hospital, islamabad. Forequarter interscapulothoracic amputation is a major ablative surgical procedure that was originally described to manage traumatic injuries of the upper extremity. Improved shoulder contour following forequarter amputation with an osteomyocutaneous free flap from the amputated extremity. The foreleg, shoulder, and adjacent lateral parts of an animal, especially a horse. Shoulder disarticulation or forequarter amputation back to all levels tips for upper extremity amputees video playlist. We describe a variation of the technique of transthoracic forequarter amputation, consisting of a completely anterior approach, removal of the left forequarter en bloc with the chest wall and lung, and sparing of the scapula. The rhomboid muscles, trapezius, levator scapulae and. Free fillet flap application to cover forequarter or traumatic. After a well designed exposure sparing the ipsilateral mamma, an osteotomy anteriorly through the sternum, as. Later, in 1836, dixie crosby described its use for cancer treatment. Mri scan showing an extremely large axillary sarcoma involving the shoulder joint. Forequarter amputation contraindicated with distant disease radical forequarter amputation with chest wall resection hemithoracetomy is indicated with chest wall involvement hemithoracectomy and free extended forearm flap reported thoracotomy is perform. Unfortunately, the patient died of gangrene a few days following the procedure.
The skin is prepared, and the tumorbearing extremity is draped free. It is performed most frequently for malignancy, although selected benign tumors, osteomyelitis of the shoulder girdle, extensive injuries, and. The patient was placed in a left lateral decubitus position to expose the thorax, with the upper extremity freely able to rotate. The aim of this study was to elucidate its role in surgical oncology. Looking for online definition of hindquarter amputation in the medical dictionary. Forequarter amputation wound coverage with an ipsilateral, lymphedematous, circumferential forearm fasciocutaneous free flap in patients undergoing palliative shouldergirdle tumor resection. The surgical technique for forequarter amputation has been described in a stepbystep fashion. The earliest report on the use of surgical forequarter amputation, or interscapulothoracic amputation, was published by cuming in 1829. Forequarter amputation for malignant tumours of the upper. Forequarter or inter scapulothoracic amputation is an uncommonly performed operation for malignant.
When free flap coverage of extended forequarter amputation is required, the preferable flap is a fillet flap from the amputated extremity. The major difference between these two levels is that some shoulder movement is retained with a shoulder disarticulation. Pdf forequarter amputation as a lifesaving procedure. Forequarter amputation combined with chest wall resection. The amputee coalition does not endorse any specific treatment, technology, company, service or device. Unfortunately the term come from the slaughter term for the front shoulder of the beef verse the hind quarter of the beef. Pdf forequarter amputation and immediate reconstruction with a. In 1887, paul berger published a classic description of an anterior approach to forequarter amputation. Objectives participants will be able to identify common causes for upper and lower extremity amputation and demonstrate an understanding of the medical. A novel reconstructive technique used the full circumference of the forearm tissue with an intact ulna as a free osseomyocutaneous flap. Forequarter amputation for tumours of the upper extremity. Traditional approaches involve bone and soft tissue resection, followed by ligation of the axillary vessels.
Softtissue sarcomas are a group of rare malignant tumours, many of which arise in the limbs. We elected to proceed with an extended forequarter amputation involving 9 complete ribs of the chest ej. Forequarter amputation following preoperative embolization to. Forequarter amputation and immediate reconstruction with a free.
Forequarter interscapulothoracic amputation was first performed by ralph cuming in 1808. Forequarter or inter scapulothoracic amputation is an uncommonly performed operation for malignant tumours involving the proximal end of humerus and the. It must have adequate strength sensation, mobility and free from complication for functional use of prosthesis. Forequarter amputation, also called interscapulothoracic amputation, involves the removal of the whole upper extremity, the scapula, and a portion of the clavicle. Correct with cosmetic shoulder cap to restore normal appearance for clothing, but differing in that an extension usually goes around and over the sound shoulder to provide additional suspension. Perioperative analgesia for forequarter amputation in a child. We first prepared a large fasciocutaneous forearm free flap based on the brachial vessels. Amputation is the intentional surgical removal of a limb or body part. Forequarter amputation fqa is an important treatment for malignant disease of the shoulder girdle. We describe a technique to minimize blood loss whereby control of the subclavian vessels is performed before amputation of a. Shoulder disarticulation and forequarter amputation are usually related to. Synonyms for forequarter amputation in free thesaurus. This study presents the fqarelated data of 30 patients mean age 50 years treated between 2000 and 2012. Forequarter amputation combined with chest wall resection is a rarely performed procedure.
Upper extremity amputations portnotes orthopaedicsone. Palliative forequarter amputation for recurrent breast. Resection and immediate reconstruction with a free radial forearm flap extended from the distal third of the arm to the midpalmar. Interscapulothoracic, or forequarter, amputation is a disfiguring operation and is done much less frequently than its counterpart in the lower extremity. Reconstruction may be achieved with an extended forearm osseomyocutaneous free flap with an excellent functional.