title: A single incision surgical new anterior technique for forequarter amputation.
abstract: BACKGROUND
  Conventionally described standard techniques of forequarter amputation may not be suitable for patients presenting with neglected or maltreated very large tumors of the proximal humerus.
  
  
  METHODS
  Eleven patients with unsalvageable malignant tumors of proximal humerus, who underwent forequarter amputation using a new technique between Jan 2008 to March 2010, were retrospectively analysed. This new single incision anterior approach involves supine positioning of patients, ligation of axillary vessels in the axilla followed by resection of muscles from lateral border and inferior angle of scapula, resection of lateral one-third of clavicle; resection of muscles from vertebral border and superior angle of scapula by applying superolateral traction without any incision over acromioclavicular axis or posterior scapular skin.
  
  
  RESULTS
  The average age was 16.27 year and minimum follow-up was 6 months (range 6-24 months). There were seven males and four females. Average duration of surgery was 62 min (range 55-90). Blood loss ranged from 400 to 750 ml. One patient had superficial infection and one patient with metastatic lesion died at 6 months follow-up.
  
  
  CONCLUSIONS
  This technique is safe, easy, less time consuming, involves small single incision in supine position, has better wound healing and can be used for both small and large tumors of proximal humerus with or without involvement of axillary vessels. Although there was no local recurrence for last 24 months but a long term follow-up is required to comment on its actual rate.
authors.affiliation: Department of Orthopaedics, All India Institute of Medical Sciences, Delhi 110070, India. akkadamb2004@gmail.com
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumar
authors.forename: Sameer
authors.initials: S
authors.lastname: Naranje
authors.forename: Himanshu
authors.initials: H
authors.lastname: Gupta
authors.forename: Shah Alam
authors.initials: SA
authors.lastname: Khan
authors.forename: Chandra Shekhar
authors.initials: CS
authors.lastname: Yadav
authors.forename: Shishir
authors.initials: S
authors.lastname: Rastogi
authors.forename: Shivanand
authors.initials: S
authors.lastname: Gamanagatti
authors.forename: Sammeer
authors.initials: S
authors.lastname: Bakhshi
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical / Q000009:adverse effects / Q000379:methods*; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006811:Humerus / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome