Forequarter amputation: Chondrosarcoma of the proximal humerus
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Forequarter amputation removes the upper limb, scapula and lateral shoulder girdle en-bloc to achieve eradication of malignant tumours when limb-salvage is not possible.
Chondrosarcoma (CS) is the second most common primary bone tumour and the most common in adults. These range from low to high grade malignant cartilage tumours which may metastasise to the lungs. They are relatively insensitive to chemo- or radiotherapy meaning that surgery is the principal intervention. Five year survival ranges from 99% for low grade to 24% for dedifferentiated chondrosarcomas. Achieving adequate surgical margins to ensure the tumour is excised-bloc is the guiding oncological principle to avoid local recurrence; local recurrence is associated with metastasis and death. Therefore, in patients in whom limb-salvage is impossible due to tumour encroachment on nerves, blood vessels and joints, amputation may regrettably be the optimal oncological treatment for their chondrosarcoma.
Patients should undergo detailed pre-operative staging and counselling prior to ablative surgery, including pre-operative assessment at a limb-fitting centre with specialist orthotists, physiotherapists and rehabilitation clinicians to optimise post-operative rehabilitation.
Author: Jonathan Stevenson FRCS (Tr & Orth).
Institution: Royal Orthopaedic Hospital, Birmingham,UK.
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