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Forequarter Amputation and Reconstructive Options.

Erkki Tukiainen1, Ian Barner-Rasmussen1, Pentscho Popov1

  • 1From the Division of Plastic Surgery, HUS Helsinki University Hospital and University of Helsinki, Helsinki.

Annals of Plastic Surgery
|March 10, 2020
PubMed
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Forequarter amputation (FQA) remains a viable option for select shoulder girdle tumors when limb-sparing surgery isn't possible. Reconstruction using free flaps, particularly from the amputated limb, is effective for extensive defects.

Area of Science:

  • Surgical Oncology
  • Reconstructive Surgery
  • Orthopedic Oncology

Background:

  • Forequarter amputation (FQA) is a rare procedure, often considered when limb-sparing treatments for extremity malignancies are not feasible.
  • It offers a limb salvage option for shoulder girdle or proximal upper extremity tumors that cannot be resected otherwise.

Purpose of the Study:

  • To present the outcomes of forequarter amputations (FQAs).
  • To evaluate the effectiveness of various reconstructive methods following FQA.

Main Methods:

  • Retrospective review of 34 patients who underwent FQA between 1989 and 2017.
  • Analysis of diverse reconstructive techniques, including free fillet flaps sourced from the amputated extremity.

Main Results:

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  • Patients presented with severe symptoms like pain, neurological deficits, or edema; 17 had palliative treatment.
  • Free flap reconstruction was required in 15 patients (11 from the amputated limb), with no flap loss or operative mortality.
  • Five-year disease-specific survival was 60% in curative cases; median survival was 13 months in palliative cases.

Conclusions:

  • While limb-sparing surgery is preferred, FQA can be the sole curative option for specific tumors.
  • FQA provides significant symptom relief and disease-free intervals in palliative settings.
  • Free flaps, especially from the resected limb, offer reliable reconstruction for large defects post-FQA.