Forequarter Amputation and Resection of Ribs 1-4 for Chronic Osteomyelitis

Area of Science:

• Orthopedics
• Surgical Oncology
• Infectious Diseases

Background:

• A 78-year-old woman with a history of breast cancer, melanoma, and radiation therapy presented with chronic osteomyelitis and radiation necrosis.
• The patient experienced worsening symptoms including significant lymphedema and loss of motor function in the left upper extremity despite vancomycin treatment.

Observation:

• The chronic osteomyelitis and radiation necrosis affected the clavicle, scapula, and upper ribs.
• Disease progression and limb dysfunction led to the consideration of forequarter amputation.

Findings:

• A forequarter amputation was performed, involving the removal of the left clavicle, scapula, ribs 1-4, and the entire upper extremity.
• The surgical intervention was successful, leading to the resolution of osteomyelitis and necrosis.

Implications:

• The patient regained independence in all activities of daily living within one month post-surgery.
• This case demonstrates the potential of forequarter amputation as a viable option for refractory proximal upper extremity and chest wall osteomyelitis, extending its utility beyond trauma and sarcoma.
• Surgical intervention can significantly improve quality of life in select cases of complex infections and radiation-induced tissue damage.