Forequarter Amputation (Scapulothoracic Disarticulation)

Incision

Start
- lateral to the clavicular insertion of the sternocleidomastoid muscle
extend the incision distally along the clavicle to the acromioclavicular joint over the acromion to the spine of the scapula & posteriorly along the vertebral border of the scapula.
lower incision
- at the middle third of the clavicle.
- Proceed distally to the deltopectoral groove & cross the axilla horizontally, & join the first incision posteriorly at the spine of the scapula.

Release the pectoralis major from the clavicle
divide the clavicle
- lateral to the insertion of the sternocleidomastoid
- Excise the clavicle to the level of the acromioclavicular joint.
ligate the external jugular vein
release the pectoralis major & minor from their insertions
expose the neurovascular bundle.
Ligate & divide the subclavian artery & vein
Section the components of the brachial plexus, & allow them to retract.
Release the latissimus dorsi & axillary fascia from the humerus
allow the limb to fall posteriorly
Hold the arm across the chest, & from superiorly to inferiorly divide the remaining muscles that fix the shoulder to the scapula.
Divide the muscles that hold the scapula to the thorax, starting with the trapezius & continuing through the omohyoid, levator scapulae, rhomboid major & minor, & serratus anterior.
Remove the arm & scapula.
Suture the remaining muscle over the lateral chest wall
Close the skin flaps over suction drainage.