title: Interscapulothoracic (forequarter) amputation for malignant tumors involving the upper extremity: surgical technique and case series.
abstract: BACKGROUND
  Forequarter amputation (FQA) is reserved for large, multifocal, or recurrent tumors affecting the shoulder and upper extremity. Although it is performed less frequently with the advancement of limb salvage surgery, FQA remains an important treatment in select patients. The purpose of this study is to illustrate the surgical technique in a case series of 4 patients.
  
  
  METHODS
  Between 2010 and 2012, 4 patients (mean age, 61 years; range, 36-78 years) presented with malignant disease of the upper extremity that was not amenable to or had failed limb salvage. All patients had FQA by the illustrated anterior clavicular osteotomy technique. Patient data were retrospectively reviewed from preoperative workup until last follow-up or death.
  
  
  RESULTS
  All patients had tumors that involved major neurovascular structures of the upper extremity and shoulder girdle. One presented with neuroendocrine carcinoma and has achieved local control after FQA. Three presented with high-grade sarcoma. One of these had recurrence after prior limb salvage and neoadjuvant radiation and unfortunately succumbed to metastatic disease 6 months after FQA. An additional sarcoma patient who presented after shoulder arthroscopy for a "labral cyst" with recurrent and fulminant synovial sarcoma succumbed to her disease. The remaining sarcoma patient has had no recurrence and minimal phantom pain at last follow-up.
  
  
  CONCLUSIONS
  Obtaining vascular control early in the procedure is crucial to minimize blood loss. When it is indicated, FQA is a relatively safe and reliable procedure for dealing with otherwise challenging tumors of the shoulder girdle and upper extremity.
  
  
  METHODS
  Level IV, case series, treatment study.
authors.affiliation: Ochsner Clinic Foundation, Department of Orthopaedic Surgery, New Orleans, LA, USA.
authors.forename: Rabah
authors.initials: R
authors.lastname: Qadir
authors.affiliation: Ochsner Clinic Foundation, Department of Orthopaedic Surgery, New Orleans, LA, USA.
authors.forename: Sanbir
authors.initials: S
authors.lastname: Sidhu
authors.affiliation: Ochsner Clinic Foundation, Department of Orthopaedic Surgery, New Orleans, LA, USA.
authors.forename: Lucas
authors.initials: L
authors.lastname: Romine
authors.affiliation: Ochsner Clinic Foundation, Department of Orthopaedic Surgery, New Orleans, LA, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Meyer
authors.affiliation: Ochsner Clinic Foundation, Department of Orthopaedic Surgery, New Orleans, LA, USA. Electronic address: Duncan.academic@gmail.com.
authors.forename: Scott F M
authors.initials: SF
authors.lastname: Duncan
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000379:methods*; D002968:Clavicle / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D012189:Retrospective Studies; D012540:Scapula / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000473:pathology / Q000601:surgery*; D035441:Thoracic Wall / Q000601:surgery; D034941:Upper Extremity / Q000601:surgery*
keywords: Forequarter amputation; interscapulothoracic; sarcoma; shoulder girdle; surgical technique