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Impairment of amputations
Published in Ramar Sabapathi Vinayagam, Integrated Evaluation of Disability, 2019
Based on the concept of combined motor, sensory, vascular, and dermal loss, a forequarter amputation derives a whole person impairment of 80%, shoulder disarticulation 79%, elbow disarticulation 72%, and wrist disarticulation 65% (Figures 15.1 and 15.2).
The breast
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Lymphangiosarcoma is a rare complication of lymphoedema with an onset many years after the original treatment. It takes the form of multiple subcutaneous nodules in the upper limb and must be distinguished from recurrent carcinoma of the breast. The prognosis is poor but some cases respond to cytotoxic therapy or irradiation. Interscapulothoracic (forequarter) amputation is rarely indicated.
Orthopaedic operations
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Michael Whitehouse, David Warwick, Ashley Blom
Interscapulo-thoracic (forequarter) amputation This mutilating operation should be done only for traumatic avulsion of the upper limb (a rare event), when it offers the hope of eradicating a malignant tumour, or as palliation for otherwise intractable sepsis or pain.
The forearm fillet flap: ‘spare parts’ reconstruction for forequarter amputations*
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Haripriya S. Ayyala, Omar M. Mohamed, Paul J. Therattil, Edward S. Lee, Jonathan D. Keith
A 30-year-old female presented with a second recurrence of high-grade sarcoma of the left supraclavicular region (Figure 2). She had previously undergone radical resection of a proximal humeral osteosarcoma with implantation of a reverse total shoulder arthroplasty, complicated by recurrence two years later. This was radically resected with removal of the endoprosthesis and reconstructed with a pedicled latissimus dorsi muscle flap. A multi-disciplinary surgical team planned for re-resection and reconstruction with a free forearm fillet flap. Prior to tumor resection, the flap was elevated as a fasciocutaneous flap from distal to proximal utilizing a stocking-seam incision with inclusion of ulnar and radial arteries. As there was an expected delay with several hours of cold ischemia time, muscle was not included in the forearm fillet flap. Avoiding the inclusion of muscle reduced blood loss and allowed for an increased ischemia time with decreased reperfusion injury. The internal mammary artery and vein were chosen as recipient vessels as the tumor abutted the proximal axillary vessels. Radical tumor resection was performed resulting in forequarter amputation with a defect measuring 1000 cm2. After negative margins were confirmed, microvascular anastomosis was performed in an end-to-end manner, connecting the brachial artery and cephalic vein to the internal mammary artery and vein, respectively. The flap was trimmed and inset, and perfusion confirmed with indocyanine green fluorescent imaging. The patient healed with no complications at with no cancer recurrence in the flap, but eventually succumbed to her disease.
Erector spinae plane block versus intraarticular injection of local anesthetic for postoperative analgesia in patients undergoing shoulder arthroscopy: A randomized controlled study
Published in Egyptian Journal of Anaesthesia, 2021
Taysser M Abdelraheem, Waleed Mohamed Ewais, Mohamed Ahmed Lotfy
Further studies are needed to compare thoracic with cervical ESPB. A cadaveric study [24] showed that US-guided ESPB at C6 and C7 stained the roots of the brachial plexus and dorsal rami. Also, a case report [25] demonstrated that ESPB at C7 controlled post-shoulder disarticulation acute pain. Moreover, a case report for forequarter amputation [26] showed that insertion of ESPB catheter threaded from the thoracic region to cervical region was an effective, method.
Synchronous oligometastases in cervical cancer: a case report
Published in Southern African Journal of Gynaecological Oncology, 2018
BT Guzha, N Ngxola, T Adams, L Rogers, N Mbatani, H-T Wu, N Fakie, V Muzenda, LA Denny
She was referred to plastic surgeons for an opinion on possible excision. Their opinion was that, due to its size and location, the lesion was not amenable to local excision. Since she had oligometastatic disease (based on whole-body CT scan and bone scan), she was offered a salvage right upper limb forequarter amputation. Positron emission tomography (PET) combined with CT scan was considered, but the tumour board was of the opinion that since the surgery was indicated for sepsis further imaging was not going to change her management. The patient and her family were agreeable to the plan. Her histology report and slides were reviewed by the tumour board (see figure 2). The gross specimen showed an arm amputation with a 122 mm × 80 mm × 60 mm tumour in the deltoid area involving the anterolateral aspect of the upper arm. There was overlying skin ulceration. Yellow-green pus was present within the tumour. The tumour was clear of all resection margins. The neurovascular bundles, the humerus and the shoulder joint were also uninvolved. The microscopic examination showed ulcerated skin with an underlying deposit of moderately differentiated non-keratinizing squamous cell carcinoma involving the dermis of the skin, the underlying subcutaneous adipose tissue and skeletal muscle. The tumour focally extended to the epidermis. The tumour was composed of nests and large islands of non-keratinising squamous cells with large areas of central necrosis. There was no sarcomatous differentiation, and there was no involvement of the neurovascular bundles. The margins were clear of the tumour (superior 4 mm, inferior margin > 25 mm, lateral 33 mm and medial >22 mm). The tumour showed positive immunostaining for p63 and p16, consistent with squamous differentiation and cervical origin. She missed her scheduled postoperative appointment but came to the combined radiation and gynaecological oncology clinic three months after her surgery, and she had fully recovered. She was seeing an occupational therapist for rehabilitation.