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Shoulder Disarticulation & Amputation Through Surgical Neck

Operative Technique

  1. Racquet incision from tip of coracoid, along anterior deltoid ,over deltoid insertion laterally, along posterior deltoid to posterior axillary fold, then back across the axilla to the anterior side
  2. Ligate cephalic vein
  3. Reflect pectoralis major off its insertion
  4. Locate neurovascular structures in interval between coracobrachialis and pectoralis minor
  5. Ligate axillary artery and divide nerves under gentle tension allowing them to retract
  6. Reflect deltoid off its insertion and divide latisimus dorsi and teres major near the bicipital groove
  7. Divide biceps and triceps tendons 2 cm distal to the level of bony resection (at origin of disarticulation)
  8. For proximal amputation
    1. Resect bone at desired level
    2. Suture the LHT, LHB + SHB, and coracobrachialis over the end of the humerus 
    3. Swing pectoralis major laterally and suture to the end of the bone
  9. For disarticulation
    1. divide capsule and rotator cuff
    2. Reflect the cut ends of all the muscles over the glenoid and suture them there 
    3. Secure muscle ends over the glenoid cavity
    4. Bring the deltoid flap inferiorly and suture just inferior to the glenoid
    5. Trim coracoid if too prominent
  10. Close skin over drains

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