• Ashok Kumar, Sameer Naranje, Himanshu Gupta, Shah Alam Khan, Chandra Shekhar Yadav, Shishir Rastogi, Shivanand Gamanagatti, and Sammeer Bakhshi.
• Department of Orthopaedics, All India Institute of Medical Sciences, Delhi 110070, India. akkadamb2004@gmail.com
• Arch Orthop Trauma Surg. 2011 Jul 1; 131 (7): 955961955-61.

BackgroundConventionally described standard techniques of forequarter amputation may not be suitable for patients presenting with neglected or maltreated very large tumors of the proximal humerus.Patients And MethodsEleven patients with unsalvageable malignant tumors of proximal humerus, who underwent forequarter amputation using a new technique between Jan 2008 to March 2010, were retrospectively analysed. This new single incision anterior approach involves supine positioning of patients, ligation of axillary vessels in the axilla followed by resection of muscles from lateral border and inferior angle of scapula, resection of lateral one-third of clavicle; resection of muscles from vertebral border and superior angle of scapula by applying superolateral traction without any incision over acromioclavicular axis or posterior scapular skin.ResultsThe average age was 16.27 year and minimum follow-up was 6 months (range 6-24 months). There were seven males and four females. Average duration of surgery was 62 min (range 55-90). Blood loss ranged from 400 to 750 ml. One patient had superficial infection and one patient with metastatic lesion died at 6 months follow-up.ConclusionsThis technique is safe, easy, less time consuming, involves small single incision in supine position, has better wound healing and can be used for both small and large tumors of proximal humerus with or without involvement of axillary vessels. Although there was no local recurrence for last 24 months but a long term follow-up is required to comment on its actual rate.

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