Interthoracoscapular amputation (forequarter)
CPT4 code
Name of the Procedure:
Interthoracoscapular Amputation (Forequarter Amputation)
Summary
An interthoracoscapular amputation, commonly known as a forequarter amputation, is a surgical procedure that involves the removal of the entire arm, including the shoulder blade (scapula) and collarbone (clavicle). This is an extensive surgery usually performed to treat severe malignancies or traumatic injuries.
Purpose
The procedure is primarily done to remove malignant tumors, such as sarcomas, that involve the upper arm and shoulder region. It may also be necessary for severe trauma where the limb cannot be salvaged. The goal is to remove the diseased or damaged tissue completely to potentially save the patient's life or prevent further complications.
Indications
- Primary bone or soft tissue sarcomas in the shoulder or upper arm.
- Extensive trauma to the shoulder and arm that cannot be repaired.
- Recurrent infections or non-healing ulcers in the upper limb.
- Severe neuropathic pain unmanageable by other treatments.
Preparation
- Pre-procedure fasting usually starting the night before the surgery.
- Discontinuation of certain medications like blood thinners as advised by the physician.
- Comprehensive diagnostic imaging (MRI, CT scans) to map the extent of the disease.
- Pre-operative consultations with the surgical team, anesthesiologist, and possibly a physical therapist.
Procedure Description
- The patient is administered general anesthesia.
- The surgeon makes an incision around the shoulder, extending to the chest and upper back.
- Major blood vessels, nerves, and muscles are carefully separated and ligated.
- The arm, along with the scapula and part of the clavicle, is removed.
- The surgical area is thoroughly inspected for any remaining malignant tissue.
- The wound is closed using sutures and drains are placed to remove excess fluids.
- A dressing is applied, and the patient is moved to a recovery room.
Duration
The surgery typically takes between 4 to 6 hours.
Setting
The procedure is performed in a hospital operating room.
Personnel
- Orthopedic or oncological surgeon
- Surgical nurses
- Anesthesiologist
- Surgical assistant(s)
Risks and Complications
- Common risks: infection, bleeding, blood clots, and wound complications.
- Rare risks: severe allergic reactions to anesthesia, damage to adjacent organs or tissues, and chronic pain.
- Possible complications include phantom limb pain and complications from general anesthesia.
Benefits
- Potentially life-saving by removing malignant tissue.
- Prevention of the spread of cancer or resolution of severe infections/trauma.
- Improved overall quality of life by alleviating severe pain or other symptoms.
Recovery
- Initial hospital stay may range from 5 to 10 days.
- Pain management with prescribed medications.
- Physical therapy for adapting to life post-amputation.
- Regular follow-up appointments to monitor healing and check for any complications.
- Expected full recovery can be several weeks to months depending on the individual's overall health and rehabilitation progress.
Alternatives
- Limb-sparing surgery when feasible.
- Radiation therapy or chemotherapy alone in cases where surgery is not possible.
- Conservative management for less severe conditions.
Patient Experience
- The patient will be under general anesthesia and therefore asleep and pain-free during the surgery.
- Post-operatively, pain and discomfort can be managed with medications.
- Significant adaptation period will be needed for new functional limitations.
- Emotional and psychological support may be necessary to cope with body image changes and new lifestyle adjustments.