Explaining Amputation of Upper Limb Reference from -Cambell Book of Orthopaedics

1. Cutting
of extremity or part of
extremity through the
bone.
Cutting of extremity or
part of extremity
through joint.

2. INDICATIONS :
1. Peripheral Vascular Disease (60-70% in LE)
 DM
 ARTERIOSCLROSIS
 THROMBOEMBOLISM
2. SEVERE TRAUMATIZED LIMB (75-80% in UE)
3. BURNS
4. FROSTBITE
1. Malignmant Tumors
2. Lethal spsis
3. Crush imjury leading to crush syndrome
 Remainig the limb is more worse than having no limb at
all.......Because of :
1. Pain
2. Gross malformation
3. Recurrent Sepsis
4. Sever loss of function

3. Mangled extremity score - upper extremity has a far greater impact on
overall function than does a lower extremity amputation.

34. Forequarter Amputation (Scapulothoracic Disarticulation)

35. In the anterior approach to forequarter
amputation :
INCISION
Upper limb of incision extends from
laterl bordr of SCM – clavicle – AC Joint –
Superior border of Scapula – Scapula
spine,body and angle.
Posterior limb from mid clavicle to the
AXILLA to join Upper Limb.

36. Deep disection through clavicle and divide it @ lateral border
of SCM, remove it by dividing the ACJ.
Release P.MAJOR from Humerus
Release P.MINOR from Coracoid Process.exposure of “NVB” –
LIGATE IT
Dissect the brachial plexus – nerves in sequence after taking
inferiorly.
Release L.DORSI Divide remaining muscles to fix shoulder to
scapula.
Also,divide muscles that hold the scapula to thorax- Trapezius,
Omohyoid, Levator Scapule, Rhomboidus, S.anterior.
Suture P.MAJOR and Trapezius on lateral wall. Drain. Skin
Closure.

37.  Patient in Lateral Decubitus
Position.
 TWO INCISIONS :
 POSTERIOR INCISION FIRST
FROM MEDIAL SIDE OF
CLAVICLE - OVER ACROMION
PROCESS –TO POSTERIOR
AXILLARY FOLD –AXILLARY
BORDER OF SCAPULA-INFERIOR
TO SCAPULAR ANGLE.AND
MEDIALLY TO END 5 CM FROM
MIDLINE.
 ANTERIOR INCISION FROM
INFERIOR ANGLE OF SCAPULA
TO THE CLAVICLE.

38. IDENTIFY TRAPEZIUS AND L.DORSI AND DIVIDE NEAR THE
SCAPULA.
DRAW SCAPULA FROM CHEST,AND DIVIDE LEVATOR
SCAPULAE AND RHOMOBOIDS.DIVIDE INSERTIONS OF
S.ANTERIOR.
DIVIDE SUBCLAVIUS MUSCLE AND CLAVICLE @ MEDIAL END
OF BONE.
DIVIDE CORDS OF BRACHIAL PLAEXUS.
DOUBLY LIGATE THE SUBCLAVIAN ARTERY AND VEIN.
AVOID INJURY TO PLEURAL DOME.
DIVIDE OMOHYOID AND LIGATE EJV AND SUPRASCAPULAR
VESSLES.
MAKE ANTERIOR INCISION.
DIVIDE P.MAJOR AND P.MINOR AND REMOVE THE LIMB.
CLOSE THE FLASPS.