Forequarter amputation combined with chest wall resection: a single-center experience

Area of Science:

• Surgical Oncology
• Thoracic Surgery
• Reconstructive Surgery

Background:

• Forequarter amputation combined with chest wall resection is a rare procedure for advanced malignancies.
• Indications include uncontrollable pain, lymphedema, limb dysfunction, and tumor ulceration.
• The surgery involves radical upper limb and shoulder girdle amputation with thoracic chest wall resection (2-7 ribs).

Purpose of the Study:

• To evaluate the feasibility and outcomes of forequarter amputation with chest wall resection for advanced shoulder girdle malignancies.
• To assess patient survival and morbidity associated with this extensive surgical procedure.

Main Methods:

• Six patients with advanced malignancies underwent forequarter amputation and chest wall resection.
• Chest wall reconstruction utilized polytetrafluoroethylene (PTFE) patches or a combination of metal implants and PTFE patches.
• Myocutaneous coverage involved pedicled flaps or free flaps harvested from the amputated forearm.

Main Results:

• No perioperative mortality was observed.
• Significant morbidity, including vascular problems requiring revision, occurred with free forearm flaps.
• Survival ranged from 5 to 50 months, with a median of 23.5 months; three patients were alive at follow-up.

Conclusions:

• Forequarter amputation with chest wall resection is a viable treatment for malignant tumors of the shoulder girdle invading the chest wall.
• The procedure provides immediate palliation.
• Long-term survival is achievable in carefully selected patients.