Forequarter amputation as a life-saving procedure

Abstract

Forequarter amputation is performed for high-grade malignant tumours in the proximal part of the upper extremity with palliative or curative intentions. Two cases are included in this report of patients who presented in need of urgent surgical intervention. Both patients had an actively bleeding, ulcerated or fungating mass and were haemodynamically unstable. The purpose of this report is to highlight the importance of emergency surgical intervention for such selected patients.

Forequarter Amputation Following Pre-Operative Embolization to Treat Two Upper Extremity Malignancies in a Previously Irradiated Tissue Bed: A Case Report

“…Forequarter amputation is an uncommon procedure that is typically performed to treat aggressive primary soft tissue sarcomas and their recurrences [1,[11][12][13]. Although significant improvement in quality of life can be observed [1,13], post-operative complications are frequent and include bleeding, wound dehiscence and necrosis [13] phantom pain [2,14,15] high rates of early local and distant recurrences and high post-operative mortality rates [16]. Although forequarter amputations are performed for curative management [15,17], this type of procedure has typically been described in the context of palliative surgery with a post-operative survival of less than 2 years [15,18,19].…”

“…Forequarter amputations typically involve removing the entire upper extremity, scapula and part of, or the entire clavicle for palliative, curative purposes [1] and even as a life-saving procedure in hemodynamically unstable patients [2]. The first forequarter amputation was performed in 1808 to treat a gunshot wound [3] while the first forequarter amputation to treat an upper extremity malignancy was performed in 1836 [4].…”

“…However, major upper limb amputations remain a necessary treatment for aggressive or recurrent malignancies when limb preserving techniques have been exhausted [1]. The indications for forequarter amputation are well described and include intractable pain, neurovascular compromise, fungating local tumour growth and the inability to maintain limb function with complete resection margins [2,6]. The majority of radical extremity amputations are performed for high grade soft tissue sarcomas and squamous cell carcinomas [1,7].…”

Upper Extremity Amputations and Prosthetics

“…39 Nevertheless, when appropriate the procedure may improve quality of life and can be lifesaving. 40…”

Forequarter Amputation and Immediate Reconstruction with a Free Extended Humeral-Radial Forearm Flap

“…There have been described many techniques for reconstruction based on the type of resection that vary from local fasciocutaneous flaps in minor resections, 3 deltoid flap, 7 local + vacuum–assisted therapy, and skin grafts 8 to more complex surgeries as a free osteomyocutaneous forearm flap with intact ulna 9 and the whole osteomyocutaneous forearm segments. 10 …”