Scapulothoracic dissociation, although rare, causes significant morbidity and mortality by completely disrupting the attachments of the scapula to the axial skeleton with the skin remaining intact. The defining constellation of injuries is subclavian or axillary vascular disruption, lateral displacement of the scapula, separation of the clavicular articulations with or without fracture of the clavicle, and cervical nerve root avulsion or brachial plexus injury. Orthopedic stabilization, vascular repair, and brachial plexus exploration are mandatory. Above elbow amputation, either primarily or within 24 hours, is recommended for the flail extremity.