Middle 1/3 Amputation of Upper Arm

Amputation and joint dissection is a destructive procedure that has long been regarded as the primary means of surgical treatment of malignant bone tumors, saving the lives of patients at the expense of limbs. In recent years, with the widespread use of effective chemotherapeutic drugs and the advancement of surgical techniques, especially the extensive extensive resection of the limbs, attempts to treat malignant bone tumors have yielded satisfactory results, and the indications for amputation surgery have been reduced. According to the new concept of localized tumor resection, the role of amputation and joint dissection in the treatment of malignant bone tumors should be re-recognized. Due to the different planes of amputation, amputation or joint dissection may be radical tumor resection, or extensive tumor resection, or marginal tumor resection. Therefore, amputation or joint dissection does not always achieve radical resection of malignant bone tumors. Nevertheless, amputation and joint dissection are still one of the main methods to achieve radical resection of malignant bone tumors. When the limb is indeed unable to be retained, the amputation or joint dissection should be performed decisively. The indications for amputation and joint dissection are: 1. Primary high-grade malignant bone tumor, there is no distant metastasis, that is, surgical staging is IIB and some IIA. 2. Primary high-grade malignant bone tumor, and there is metastasis, surgical stage III, such as metastatic tumor can be surgically removed; or to relieve pain, eliminate local infection of existing infections, should also be performed amputation or joint separation Broken surgery. 3. Primary malignant bone tumors, although the surgical staging is IB and IIA, but have lost the conditions for local extensive resection of the retained limbs. Amputation or joint plane selection: Determine the amputation or joint plane of the joint based on the extent of the tumor invading the bone and soft tissue and the need to install the prosthesis. Amputation at 5 to 7 cm proximal to the upper end of the tumor can achieve local extensive resection of the tumor. Since articular cartilage, bone growth plate and joint capsule are the direct spread of tumor, the radical tumor resection can be achieved by taking the proximal joint of the bone malignant tumor, and the bone growth plate of the proximal tubular bone is retained to make the stump. Grow at normal speed. Although, with the development of prosthetic technology, the requirements for the length of the stump have been relaxed in the installation of the prosthesis, that is, the effect of the length of the stump on the installation of the prosthesis has been significantly reduced, and a well-healed stump is more important. In principle, however, the length of the limb stump is preserved as much as possible while achieving radical resection of the tumor. Treatment of diseases: Pediatric hand-heart malformation syndrome Indication The upper arm 1/3 amputation applies to: 1. A malignant tumor of the hand or wrist or elbow joint. 2. A severe congenital malformation or trauma of the forearm and loss of function. Preoperative preparation 1. CT and MRI examination to determine the extent of bone tumor involvement. 2. Chest X-ray and whole body radionuclide bone scan, except for lung metastasis and bone metastasis. 3. Biopsy clear pathological diagnosis. Surgical procedure Incision The isometric flaps are designed before and after the predetermined osteotomy plane, and the length of the flap is equivalent to 1/2 of the anteroposterior diameter of the upper arm of the plane. Cut the skin and deep fascia along the incision line and free the proximal end to the top of the osteotomy plane. 2. Cut off muscles and vascular nerves First look for, reveal and double ligature and cut the axillary vein on the inside of the biceps. The phrenic, median, and ulnar nerves are severed at the proximal end of the osteotomy plane, allowing them to naturally retract to the proximal end of the osteotomy plane. Then, at 1.5 cm distal to the plane of the osteotomy, the muscles in the anterior chamber of the upper arm were cut, and the triceps tendon was cut from the olecranon to make it equal to the posterior flap. 3. Osteotomy and closed incision The triceps and the posterior flap were pulled proximally, and the periosteum was cut in a circular plane at the osteotomy plane, and the periosteum was peeled off distally. Then cut the humerus horizontally, remove the distal end of the amputation, and remove the sharp edge of the bone end. The triceps muscle is thinned, and then pulled to the front to cover the bone end, and the anterior muscle fascial flap is sutured intermittently, and a rubber drainage strip is placed on the deep side. After thorough hemostasis, the skin incision was sutured in layers. complication 1. Hemorrhage and hematoma formation Major bleeding caused by large blood vessel ligation is rare, but it should be highly vigilant. A rubber tube tourniquet was prepared at the regular bedside after surgery. Closely observe the bleeding of the dressing. Once a major bleeding is found, stop the blood band immediately and stop the operation in an emergency. 2. Phantom limb pain 3. Neuroma and residual limb pain The nerve endings have nerve fibers regenerated to form a neuroma, which is an inevitable pathological phenomenon. However, only about 10% of patients develop painful neuroma. It may be related to the compression of the nerve end by the bone end, the surrounding scar tissue wrapping and the scar adhesion. For patients who are not treated with non-surgical treatment, the neuroma can be surgically removed and the stump can be placed in the normal muscle space.