Orthopedic & Muscular System: Current Research
Open Access

Abstract

Forequarter Amputation Following Pre-Operative Embolization to Treat Two Upper Extremity Malignancies in a Previously Irradiated Tissue Bed: A Case Report

Michel Taylor and David Pichora

Forequarter amputations typically involve removing the entire upper extremity, scapula and part of, or the entire clavicle for palliative or curative purposes. Although the first forequarter amputation was performed in 1808 to treat a gunshot wound, currently the majority are performed to treat primary or recurrent soft tissue sarcomas of the proximal humerus or axilla. In the last two decades due to improved chemotherapy and radiotherapy treatments as well as improved surgical technique, there has been an increase in limb preserving surgeries at the expense of radical amputations. However major upper limb amputations remain a necessary treatment for aggressive or recurrent malignancies when limb preserving techniques have been exhausted. Forequarter amputations carry high complication rates including high local and distant recurrence, limb pain and wound complications often due to poor tissue quality, which can result from local radiation treatments. We present the case of a patient with recurrent upper extremity sarcoma and squamous cell carcinoma in a previously irradiated tissue bed that underwent a forequarter amputation with flap reconstruction following pre-operative embolization.