Amputatio interscapulo-thoracica

Amputatio interscapulo-thoracica (megapolice-breast amputation) - removal of the upper limb and a half of the shoulder girdle. Produced in malignant tumors and extensive injuries of the upper third of the shoulder, shoulder joint and shoulder girdle. Anesthesia: usually General anesthesia.
The technique of the operation. The most simple method of Crimsa Bella. Patient is placed on the healthy side with one hand raised. The section starting from the inner end of the clavicle, spend up to its external third and then down to the level of VI rib, hence through the axilla to the bottom right corner of the blade, then along the medial edge or more external, parallel to the inner edge of the blade, so that it was possible to sew the wound without the tension of the skin. Next, an incision is made through the girdle, to the border of the middle and outer thirds of the clavicle (Fig). Muscle crossed in the opposite direction, i.e. starting from the back. From the spinous processes of the vertebrae cut off the trapezius muscle, pulling it outwards, cut muscle, levator scapulae, small and big rhomboid muscle. Between the muscle that raises the blade, and the small rhomboid muscle cross back nerve shoulder blade and incremental nerve, and ahead of the muscles, levator scapulae (in a sideways triangle of the neck),- cross the arteries of the neck and shoulders with the same name veins. Spade stupidly separated from the chest and turn outwards. The medial angle cross vane-sublingual and front - front teeth, muscles. In milestones space allocate the trunks of the brachial plexus that after anesthesia tight bandage silk ligature and cut off. Somewhat lower, between ligatures, cut subclavian arteries. Collarbone on the border of the inner and middle thirds perejivayut saw Gigli.
Both the chest muscles are cut from the edges and turn outwards. At the lower angle of the blades intersect wide muscle of back, then limb along with half the shoulder belt is removed. Through the hole in the bottom end of the back flap injected rubber drainage and the wound is sutured in layers tightly.
After 1-2 months. after healing the wounds produce cosmetic or active prosthesis.
Widely applied also A. i.-th. by Berger (P. Berger). The operation begins with resection of the clavicle and bandaging subclavian vessels, which facilitates the fight against blood loss and embolism. Otherwise it is similar to the previous one.
Complications: shock, bleeding, air embolism.

Amputatio interscapulo-thoraeica: the front line of the section (1) and rear (2).