A Rare Case of Traumatic Forequarter Amputation of the Upper Extremity: Treatment Course and Outcome

Traumatic Forequarter Amputations (FQA) are exceedingly rare and carry major functional and psychosocial consequences. This report describes the emergency replantation of a 22-year-old male who sustained a complete interscapulothoracic amputation of the right upper extremity after his arm was caught in an industrial waste compactor. He arrived 62 minutes post-injury hemodynamically stable, with sharply demarcated wound margins and minimal contamination. CT imaging confirmed complete amputation with fractures of the clavicle, scapula, humerus, and a rib, along with a transected subclavian artery, hemato-pneumothorax, and extensive soft-tissue emphysema. Given the mechanism, short ischemia time, minimal limb destruction, and immediate availability of a multidisciplinary surgical team, emergency replantation began 122 minutes after injury. Parallel preparation of the thoracic stump and amputated limb minimized warm ischemia. Revascularization was achieved using long autologous venous interposition grafts, with total ischemia time of 348 minutes. Skeletal fixation included intramedullary humeral nailing and plate arthrodesis of the acromioclavicular joint. Early complications included reperfusion syndrome requiring hemofiltration and venous graft thrombosis requiring revision. Secondary reconstruction involved extensive nerve grafting, corrective clavicular osteotomy, and suprascapular neurotization. Rehabilitation emphasized edema reduction, preservation of passive mobility, and neuromuscular stimulation. At follow-up, the replanted limb survived with coarse sensory recovery but absent motor function, aligning with outcomes typically reported for shoulder-girdle-level replantation. This case highlights that, despite limited functional expectations, forequarter replantation may provide meaningful psychological and body-image benefits and remains a viable option in carefully selected patients with minimal tissue destruction and short ischemia times.