Latissimus dorsi musculocutaneous flap for elbow extension

Abstract

The latissimus dorsi mycocutaneous flap has developed a reputation for its versatility in both skin and soft tissue coverage and for restoration of elbow function in both flexion and extension. In a case presented, a large extra-abdominal desmoid was removed along with the entire deltoid and three-quarters of the triceps. The latissimus dorsi was elevated with a large overlying skin island and rotated on its neurovascular pedicle into the defect in the posterior shoulder and upper arm to replace the resected triceps and deltoid muscle, and to provide coverage in this region.

Restoration of elbow function with pedicled latissimus dorsi myocutaneous flap transfer

“…In contrast to elbow flexion, few reports have described the restoration of elbow extension. 10,16,19 Of these two movements, the act of flexion is undoubtedly more important, because gravity compensates for the work involved in elbow extension. Flexion is required for innumerable life necessities, being a movement of self-preservation, bringing the "business end" of the upper extremity toward the head and trunk.…”

“…1,12 However, if surgery is not performed within this interval, if a severe myogenic lesion of the biceps brachii muscle is involved, or if recovery of the paralyzed biceps brachii muscle does not appear within an adequate interval despite surgery, other operative approaches are needed. Many methods have been reported for restoration of elbow flexion-for example, Steindler flexorplasty, 4,11,17,24 anterior transposition of the triceps tendon, 5 transfer of the pectoralis major to the biceps, 3,7,9,21,23 shoulder arthrodesis and sternocleidomastoid transfer with extension via a fascia lata graft, 6 unipolar or bipolar transfer of the latissimus dorsi muscle, 10,[12][13][14][15][16]19,21,25,27 and free muscle grafts with motor nerve transfer. 1 Of these procedures, Steindler flexorplasty is simplest and most reli- able procedure, if the flexor pronator muscle group is available for transfer.…”

“…10,12-16,19 -21,25-27 Most reports describing latissimus dorsi myocutaneous flap transfer for elbow functional restoration have been small series of less than 10 cases, and there have been a few case reports describing elbow extension restoration. 10,[12][13][14][15][16]19,21,25,27 We report the results of 17 patients who underwent restoration of elbow flexion or extension via latissimus dorsi myocutaneous flap transfer.…”

Desmoid tumor of the forearm. Reconstructive surgery and functional result

“…Ferraresi et al [19] described an aggressive fibromatosis of the radial nerve which required tumor removal and nerve graft repair, with an excellent clinical recovery and no recurrence at the 6-year follow-up review. Pruzansky et al [20] presented a case in which a large extra-abdominal desmoid tumor was removed along with the entire deltoid and three-quarters of the triceps and a latissimus dorsi musculocutaneous flap was used to replace the resected triceps and deltoid muscle and provide coverage in this region. Goubier et al [21] reported that one patient out of seven with desmoid tumors located near the brachial plexus that was treated with resection of the tumor that involved the median nerve and a nerve graft was necessary as reconstructive surgery.…”

“…Several articles reported the functional results of the surgery [16][17][18], but only three [19][20][21] described a reconstructive procedure at the same time of the surgery. Ferraresi et al [19] described an aggressive fibromatosis of the radial nerve which required tumor removal and nerve graft repair, with an excellent clinical recovery and no recurrence at the 6-year follow-up review.…”