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Amputations & prosthetics of the upper limb

Forequarter Amputation

  • is the removal of the upper limb in the interval between the scapula and the chest wall

  • Mainly for malignancy

  • Anterior (Berger) vs posterior (Littlewood)

  • Difficult skin flaps

  • ref: Littlewood " Amputations at the shoulder and the hip" Br Med J 1: 381, 1922

Shoulder disarticulation

  1. Racquet incision from tip of coracoid, along ant deltoid ,over deltoid insertion laterally, along post deltoid to post axillary fold, then back across the axilla to the ant side
  2. Ligate cephalic vein
  3. Reflect pectoralis major off its insertion
  4. Locate neurovascular structures in interval between coracobrachialis and pectoralis minor
  5. Ligate axillary artery and divide nerves under gentle tension allowing them to retract
  6. Reflect deltoid off its insertion and divide latisimus dorsi and teres major near the bicipital groove
  7. Divide biceps and triceps tendons 2cm distal to the level of bony resection (at origin of disarticulation)
  • For proximal amputation
    • Resect bone at desired level 
    • then suture the LHT, LHB + SHB, and coracobrachialis over the end of the humerus and swing pec major laterally and suture to the end of the bone
  • For disarticulation
    1. divide capsule and rotator cuff
    2. then reflect the cut ends of all the muscles over the glenoid and suture them there - and secure muscle ends over the glenoid cavity
    3. then bring the deltoid flap inferiorly and suture just inferior to the glenoid
    4. Trim coracoid if too prominent
  • Close skin over drains


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