Forequarter amputation

Forequarter amputation is amputation of the arm, scapula and clavicle. It is usually performed as a last resort to remove a cancer, but decreasingly so as limb-sparing operations improve.^[1]

Surgical technique

The rhomboid muscles, trapezius, levator scapulae and latissimus dorsi are transected. The neurovascular bundle consisting of the axillary artery, axillary vein and brachial plexus is ligated and cut. The area of the chest left exposed is then normally covered with a split-thickness skin graft.^[1]

Society

In 2008, David Nott, a British vascular surgeon in the Democratic Republic of the Congo with Médecins Sans Frontières, performed a forequarter amputation to save the life of a 16-year-old boy, whose arm had been severed by an injury. He was left with a gangrenous stump and had a few days to live.

"The first thing I realised when I saw J was that he was dying. All that remained of this 16-year-old's arm was six inches of skin; the rest had been shot off when he became caught in gunfire between the Congolese army and rebel forces. A further amputation had left him open to infection, and now he was facing the prospect of an awful, agonising death over a period of several days – hallucinations, dehydration, his kidneys packing up, his breathing going and then, finally, his heart."^[2]

It made the news because his colleague, Joseph Meirion Thomas, sent pointers via SMS text message.^[3] The text message included 10 steps to be followed and finished by saying, "Easy! Good luck."^[4]

The text David Nott received:

"Start on clavicle. Remove middle third. Control and divide subsc art and vein. Divide large nerve trunks around these as prox as poses. Then come onto chest wall immed anterior and divide Pec maj origin from remaining clav. Divide pec minor insertion and (very imp) divide origin and get deep to serrates anterior. Your hand sweeps behind scapula. Divide all muscles attached to scapula. Stop muscle bleeding with count suture. Easy! Good luck. Meirion"^[2]

Notable People

• On August 6, 2023, a 21-year old American man named Shane Johns from Nashville, Tennessee was involved in a hit-and-run incident where he was driving his motorcycle and caused him to fly out that left him in critical condition.^[5][6] Doctors had to perform the forequarter amputation on his right arm to his shoulder because of the extensive damage the accident caused,^[7] he also claimed he had injuries to his pelvis, wrist, scalp and legs as well as his left arm that was also fractured but not as extensive compared to the right arm. Shane is a notable Tik Toker now with 84.2K followers and 2.6 Million likes.^[8]

References

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