Interscapulothoracic Amputation

AMPUTATIO INTERSCAPULO-THORACICA, the removal of the upper limb along with the corresponding half of the shoulder girdle, was first performed by Cummings for a severe gunshot wound in 1808. Another and most frequent indication is sarcoma of the humerus or scapula that has invaded the muscles. The operation is entirely typical, and in the form developed and described in 1887 by Berger, it represents the limit of radicalism. The limb is removed in its entirety, along with the scapula, clavicle, and all muscles, which are transected far into healthy tissues. The shape of the skin incision is not particularly essential and often depends on the existing trauma or tumor growth. The clavicle is sawn through in its medial third; the subclavian artery is ligated, the nerves of the brachial plexus are isolatedly anesthetized and then transected; the vein is ligated last of all, as it could have sucked back a lot of blood from the parts being removed during this time. Injury to the vein is very dangerous due to air aspiration, so before its ligation, it must be protected by all means. After division of the neurovascular bundle, both pectoral muscles, and the subclavius muscle, the limb is vigorously pulled outward and backward; the anterior surface of the scapula easily separates from the trunk, exposing from the front the broad muscles of the back: the subscapularis, rhomboid, trapezius, etc.; all of them are cut in healthy parts, and it only remains to outline the posterior skin incision so that the separated limb can finally come off. The mortality from the operation, according to Berger, in 57 cases was about 20%, but already in 1900, Fowler collected 82 cases with only an 8% mortality rate. By using local infiltration anesthesia, it is probably possible in individual cases to significantly reduce the risk. Long-term results depend entirely on the timeliness of the operation and the form of the sarcoma. The prognosis, as always in sarcomas, is doubtful; however, this is no reason to expand the field of operation. On the contrary, the proposals and quite successful attempts of Russian authors deserve full attention, who, while removing the shoulder girdle according to Berger, preserve the neurovascular bundle and the limb with the humerus sawn off in healthy parts. The cases of Bauman (Tikhov's clinic) and Linberg (Saratov) show the complete possibility of this. The radical nature of the operation should not be reduced thereby, and the remaining "short arms" can still do some work.