Often lifesaving — e.g. for large prox humerus/shoulder malignancies
Technique
Incision
Start lateral to the clavicular insertion of the sternocleidomastoid muscle
Extend the incision distally along the clavicle to the acromioclavicular joint, over the acromion, to the spine of the scapula & posteriorly along the vertebral border of the scapula
Lower incision
At the middle third of the clavicle.
Proceed distally to the deltopectoral groove & cross the axilla horizontally, & join the first incision posteriorly at the spine of the scapula.
Dissection
Release the pectoralis major from the clavicle
Divide the clavicle
Lateral to the insertion of the sternocleidomastoid
Excise the clavicle to the level of the acromioclavicular joint
Ligate the external jugular vein
Release the pectoralis major & minor from their insertions
Expose the neurovascular bundle
Ligate & divide the subclavian artery & vein
Section the components of the brachial plexus & allow them to retract
Release the latissimus dorsi & axillary fascia from the humerus
Allow the limb to fall posteriorly
Hold the arm across the chest & from superiorly to inferiorly divide the remaining muscles that fix the shoulder to the scapula
Divide the muscles that hold the scapula to the thorax, starting with the trapezius & continuing through the omohyoid, levator scapulae, rhomboid major/minor & serratus anterior
Remove the arm & scapula
Suture the remaining muscle over the lateral chest wall
