Shoulder silhouette and axilla reconstruction with free composite elbow tissue transfer following interscapulothoracic amputation * Georgios Koulaxouzidis*, Filip Simunovic, G. Bjo¨rn Stark Department of Plastic and Hand Surgery, University of Freiburg Medical Centre, 79106 Freiburg, Germany Received 19 April 2013; accepted 6 October 2013 KEYWORDS Interscapulothoracic amputation; Forequarter amputation; Free extremity flap; Spare part surgery Summary Interscapulothoracic amputation (ISTA) encompasses the removal of the upper limb, scapula and clavicle. As the reconstructive and oncologic limb-saving techniques improved, the indications for this formidable procedure decreased. However, it is still the appropriate procedure in cases with extensive oncologic or traumatic involvement of the shoulder girdle. Following ISTA, the surgeon is not only faced with a large defect but also with severe functional and aesthetic impairments. A solution to these problems is the immediate reconstruction with a free composite transfer from the amputated extremity. We successfully treated three oncologic cases and one traumatic case using this technique. The recipient ves- sels included the subclavian artery and vein in three cases and the internal thoracic vessels in one case. After a mean follow-up time of 4.5 years, two of the three tumour patients were free of recurrent disease. In all cases stable wound closure was achieved. Three out of four patients would opt for surgery again, in spite of the high occurrence of complications. One patient died after a 14-year event-free postoperative course. We conclude that the defect following ISTA can be successfully covered using a free composite tissue transfer of the amputated disease-free elbow and forearm, while simultaneously reconstructing the shoulder silhouette and axilla. This procedure reduces functional and aesthetic impairments and improves the quality of life. ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. * Part of this work was presented at the 42nd Annual Conference of the German Association of Plastic, Reconstructive and Aesthetic Surgeons (DGPRA ¨ C), 29th September 2011 till 01st October 2011. * Corresponding author. Tel.: þ49 761 270 28170; fax: þ49 761 270 25010. E-mail address: georgios.koulaxouzidis@uniklinik-freiburg.de (G. Koulaxouzidis). 1748-6815/$ - see front matter ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2013.10.040 Journal of Plastic, Reconstructive & Aesthetic Surgery (2014) 67, 81e86