Forequarter amputation is amputation of the

arm In human anatomy, the arm refers to the upper limb in common usage, although academically the term specifically means the upper arm between the glenohumeral joint (shoulder joint) and the elbow joint. The distal part of the upper limb between th ...

scapula The scapula (plural scapulae or scapulas), also known as the shoulder blade, is the bone that connects the humerus (upper arm bone) with the clavicle (collar bone). Like their connected bones, the scapulae are paired, with each scapula on eith ...

and

clavicle The clavicle, or collarbone, is a slender, S-shaped long bone approximately 6 inches (15 cm) long that serves as a strut between the shoulder blade and the sternum (breastbone). There are two clavicles, one on the left and one on the r ...

. It is usually performed as a last resort to remove a cancer, but decreasingly so as limb-sparing operations improve.

Surgical technique

The rhomboid muscles, trapezius, levator scapulae and latissimus dorsi are transected. The neurovascular bundle consisting of the

axillary artery In human anatomy, the axillary artery is a large blood vessel that conveys oxygenated blood to the lateral aspect of the thorax, the axilla (armpit) and the upper limb. Its origin is at the lateral margin of the first rib, before which it is c ...

axillary vein In human anatomy, the axillary vein is a large blood vessel that conveys blood from the lateral aspect of the thorax, axilla (armpit) and upper limb toward the heart. There is one axillary vein on each side of the body. Structure Its origin ...

and

brachial plexus The brachial plexus is a network () of nerves formed by the anterior rami of the lower four cervical nerves and first thoracic nerve ( C5, C6, C7, C8, and T1). This plexus extends from the spinal cord, through the cervicoaxillary canal in t ...

is ligated and cut. The area of the chest left exposed is then normally covered with a split-thickness

skin graft Skin grafting, a type of graft surgery, involves the transplantation of skin. The transplanted tissue is called a skin graft. Surgeons may use skin grafting to treat: * extensive wounding or trauma * burns * areas of extensive skin loss du ...

Society

In 2008, David Nott, a British vascular surgeon in the

Democratic Republic of the Congo The Democratic Republic of the Congo (french: République démocratique du Congo (RDC), colloquially "La RDC" ), informally Congo-Kinshasa, DR Congo, the DRC, the DROC, or the Congo, and formerly and also colloquially Zaire, is a country in ...

with

Médecins Sans Frontières (MSF; pronounced ), also known as Doctors Without Borders, is a humanitarian medical non-governmental organisation (NGO) or charity of French origin known for its projects in conflict zones and in countries affected by endemic diseases. ...

, performed a forequarter amputation to save the life of a 16-year-old boy, whose arm had been severed by an injury. He was left with a

gangrenous Gangrene is a type of tissue death caused by a lack of blood supply. Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness. The feet and hands are most commonly affected. If the ga ...

stump and had a few days to live. "The first thing I realised when I saw J was that he was dying. All that remained of this 16-year-old's arm was six inches of skin; the rest had been shot off when he became caught in gunfire between the Congolese army and rebel forces. A further amputation had left him open to infection, and now he was facing the prospect of an awful, agonising death over a period of several days – hallucinations, dehydration, his kidneys packing up, his breathing going and then, finally, his heart." It made the news because his colleague, Joseph Meirion Thomas, sent pointers via

SMS text message Short Message/Messaging Service, commonly abbreviated as SMS, is a text messaging service component of most telephone, Internet and mobile device systems. It uses standardized communication protocols that let mobile devices exchange short text ...

. The text message included 10 steps to be followed and finished by saying, "Easy! Good luck."Text Messaging Surgical Instructions...It's "Easy! Good Luck" - Medgadget
''(Last accessed Fri 19 Dec 2008.)'' The text David Nott received: "Start on clavicle. Remove middle third. Control and divide subsc art and vein. Divide large nerve trunks around these as prox as poses. Then come onto chest wall immed anterior and divide Pec maj origin from remaining clav. Divide pec minor insertion and (very imp) divide origin and get deep to serrates anterior. Your hand sweeps behind scapula. Divide all muscles attached to scapula. Stop muscle bleeding with count suture. Easy! Good luck. Meirion"

References

{{reflist Surgical oncology Types of amputations