Abstract
Background
Conventionally described standard techniques of forequarter amputation may not be suitable for patients presenting with neglected or maltreated very large tumors of the proximal humerus.
Patients and methods
Eleven patients with unsalvageable malignant tumors of proximal humerus, who underwent forequarter amputation using a new technique between Jan 2008 to March 2010, were retrospectively analysed. This new single incision anterior approach involves supine positioning of patients, ligation of axillary vessels in the axilla followed by resection of muscles from lateral border and inferior angle of scapula, resection of lateral one-third of clavicle; resection of muscles from vertebral border and superior angle of scapula by applying superolateral traction without any incision over acromioclavicular axis or posterior scapular skin.
Results
The average age was 16.27 year and minimum follow-up was 6 months (range 6–24 months). There were seven males and four females. Average duration of surgery was 62 min (range 55–90). Blood loss ranged from 400 to 750 ml. One patient had superficial infection and one patient with metastatic lesion died at 6 months follow-up.
Conclusions
This technique is safe, easy, less time consuming, involves small single incision in supine position, has better wound healing and can be used for both small and large tumors of proximal humerus with or without involvement of axillary vessels. Although there was no local recurrence for last 24 months but a long term follow-up is required to comment on its actual rate.
Similar content being viewed by others
References
Bhagia SM, Elek EM, Grimer RJ, Carter SR, Tillman RM (1997) Forequarter amputation for high-grade malignant tumours of the shoulder girdle. J Bone Joint Surg Br 79(6):924–926
Cleveland KB (2008) Amputations of upper extremity. In: Canale ST, Beaty JH (eds) Campbell’s operative orthopaedics, 11th edn. Mosby, Inc, Philadelphia, pp 625–637
Dimas V, Kargel J, Bauer J, Chang P (2007) Forequarter amputation for malignant tumours of the upper extremity: case report, techniques and indications. Can J Plast Surg 15(2):83–85
Littlewood H (1922) Amputations at the shoulder and at the hip. Br Med J 1:381–383
Wittig JC, Bickels J, Kollender Y, Kellar-Graney KL, Meller I, Malawer MM (2001) Palliative forequarter amputation for metastatic carcinoma to the shoulder girdle region: indications, preoperative evaluation, surgical technique, and results. J Surg Oncol 77(2):105–113
Ferrario T, Palmer P, Karakousis CP (2004) Technique of forequarter (interscapulothoracic) amputation. Clin Orthop Relat Res 423:191–195
Stafford ES, Williams GR Jr (1958) Radical transthoracic forequarter amputation. Ann Surg 148(4):699–703
Wurlitzer FP (1973) Improved technic for radical transthoracic forequarter amputation. Ann Surg 177(4):467–471
Reid CD, Taylor GI (1984) The vascular territory of the acromiothoracic axis. Br J Plast Surg 37(2):194–212
Rickelt J, Hoekstra H, van Coevorden F, de Vreeze R, Verhoef C, van Geel AN (2009) Forequarter amputation for malignancy. Br J Surg 96(7):792–798
Malawer MM, Buch RG, Thompson WE, Sugarbaker PH (1991) Major amputations done with palliative intent in the treatment of local bony complications associated with advanced cancer. J Surg Oncol 47:121–130
Conflict of interest
Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kumar, A., Naranje, S., Gupta, H. et al. A single incision surgical new anterior technique for forequarter amputation. Arch Orthop Trauma Surg 131, 955–961 (2011). https://doi.org/10.1007/s00402-010-1244-7
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-010-1244-7