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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Forequarter or inter scapulothoracic amputation is an uncommonly performed operation for malignant tumours involving the proximal end of humerus and the shoulder. A report of three cases who underwent this procedure at Federal Government Services Hospital, Islamabad is presented.

In two cases the lesion was a primary bone tumour osteogenic sarcoma and the third one was an advanced metastatic lesion of the forrquarter humerus with soft tissue involvement.

The incisions used are shown in Figure 1. Using the posterior incision first Little wood secured the neurovascular bundle before making the second anterior incision. We found it convenient to ligate the bundle under direct vision as a last forequatrer after completing the anterior dissection as well. Case 1 A female of 30 reported with amputtion slowly increasing painful mass in the right upper arm for the last three months.

Physical examination revealed a hard tender rounded mass of about 25 cm around the right upper arm ammputation prominent veins over the skin.

The radiographs and biopsy revealed osteogenic sarcoma froequarter the upper end of humerus with soft tissue involvement. Her bone and visceral scan were normal. Initially she refused surgery. After about eight-months she came back as the weight of the arm was becoming unbearable due to further increase in size.

A forequarter amputation was done. Postoperatively she developed; excessive upward lift of the breast which was corrected with plastic repair. She remained symptom- free for about fifteen months when she started deteriorating and died due to multiple secondaries in the lungs.


One day before admission he developed in-ability to move the arm with a deformity in the upper part.

It was suspected to be a secondary metastatic lesion. A search for the primary revealed a mass in the left renal area. Postoperatively he received radiotherapy arid fordquarter. He was seen again after a year and a half with painful progressive swelling of the whole upper arm with loss of function of two months duration.

Bone scan revealed increased uptake in the soft tissues of the upper limb including the shoulder joint area. A forequarter amputation was performed. He developed superficial wound infection managed successfully with appropriate antibiotics. Two years of follow-up since operation have been uneventful without any evidence of metastases. Case ajputation A young girl of 15 from Mad Kashmir presented with similar history of a slowly increasing sweffing of right upper arm for one year.

The tumour was 30 xmputation in diameter. X-rays revealed an osteodestructive lesion of the upper end of right humerus with soft tissue extension. Biopsy revealed an osteogenic sarcoma of humerus.

10A: Shoulder Disarticulation and Forequarter Amputation | O&P Virtual Library

She was referred to the radiotherapy institute where she received cytotoxic drug amputatioj. Discussion Forequarter amputation is a mutilating procedure which imparts a grave psychogenic trauma to the patient. There is an initial refusal on the part of the patient and even hesitation on the part of the treating surgeon resulting in too few such procedures being carried out even when needed 2. Techniques of limb salvage surgery and multimodality therapy like radiation, local and systemic chemotherapy are also being done for these patients 3.

In young people shoulder arthrodesis can be one of the options 4. For large tumours Tickhoff-Linberg procedure 1,5 or one forequarterr its modifications is being forequatrer provided the tumour does not extend to and involve the neurovascular bundle, the chest wall and the.

Following this technique the function of the forearm and hand are preserved. A custom humeral prosthesis 6 or an inter positional metallic device 7 may be implanted for reconstruction. But such salvage procedures can only be undertaken in well-confined and early lesions 2,3,6.


Forequarter amputation

Our cases presented at an advanced stage. Cases 1 and 3 bad the tumour six months and one year before they were admitted and biopsies taken. The tumour by thattime had extended to the chest wall.

In case 2 a limb salvage surgery was attempted for metastic lesion in the upper humerus. So all three patients had to undergo such an extensive procedure. 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.

Campbell’s operative orthopaedics, 7th ed. Interscapulothoracic amputation for sarcomas of the upper extremity. Is amputation necessary for sarcomas? A seven-year experiencewith limbsslvage. Bone tumours – evaluation and management. New York, Churchill Livingstone,p. The Tikhoff- Linberg procedure: Research articles conducted on animals, will not be considered for processing or publication in the JPMA.

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