Forequarter amputation is a major operation to remove the entire upper limb including the shoulder blade (scapula) and collarbone (clavicle). It is performed for large, aggressive tumours of the shoulder girdle when limb salvage is not possible.
An extensive incision is made around the shoulder and chest wall. The major blood vessels and nerves to the arm are divided. The entire upper limb is removed along with the scapula, clavicle, and surrounding muscles. Skin flaps are fashioned to close the defect. The operation takes three to five hours.
Forequarter amputation is reserved for locally advanced tumours that encase the brachial plexus or major vessels, making limb salvage impossible. It may also be considered for fungating or infected tumours causing severe symptoms.
Limb salvage surgery if oncologically feasible. Radiotherapy for palliation. Chemotherapy.
Specialist sarcoma centre. Full staging. MDT discussion. Psychological preparation and support.
Definitive local tumour control. Relief of pain and functional burden of a non-functional limb. Wound healing allows progression to adjuvant treatment.
Expected.
Loss of the entire upper limb profoundly affects body image and function.
Large wound with risk of seroma and delayed healing.
Chronic pain from the divided nerves.
Increased risk with prior radiotherapy.
Pneumothorax or respiratory compromise.
General anaesthesia. Major surgery with significant blood loss.
Hospital stay one to two weeks. Wound healing. Prosthetic options are limited but cosmetic prostheses are available. Intensive psychological support. Occupational therapy for adaptation to one-handed function.
Oncology surveillance. Prosthetic and rehabilitation review. Psychological support.
When the tumour involves the major nerves (brachial plexus) and blood vessels, the limb cannot be preserved with a functional outcome. Forequarter amputation provides the best chance of complete tumour removal.