Forequarter Amputation (Scapulothoracic Disarticulation)

Forequarter amputation (scapulothoracic disarticulation) removes the upper limb with the scapula and lateral clavicle, most often for large proximal humeral or shoulder girdle tumours. It is disfiguring but can be lifesaving, and early ligation of the subclavian vessels through a clavicle osteotomy controls bleeding.

General Principles

  • Highly disfiguring
  • Impairs ability to fit clothing
  • Often lifesaving — e.g. for large prox humerus/shoulder malignancies

Technique

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. 

Dissection

  • 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

Author Contributions

Page Written by Dr James Drummond

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.