Latissimus dorsi transfer to restore elbow flexion

A Case of Congenital Bilateral Absence of Elbow Flexor Muscles: Review of Differential Diagnosis and Treatment

“…There are a variety of surgical options to restore elbow flexion, and these choices depend largely on the best available muscles for transfer. Restoration of biceps function has been described by a number of pedicle muscle transfers to include pectoralis [47], triceps [30], latissimus dorsi [27,42,50,54,62], and also microvascular muscle transfers using either gracilis or latissimus dorsi muscles [4,22,26] and by advancing the flexor/pronator muscle mass up onto the humerus (Steindler transfer) [36]. Microvascular transfers are necessitated when there are no available pedicle muscle transfers.…”

“…The goal of our report is not to discuss the relative merits of these available muscle transfers nor to debate the methods and locations of proximal attachment or distal insertion of the latissimus muscle transfer, as these have all been discussed adequately elsewhere [27,42,50,54,62]. Suffice it to say that, in our patient, the latissimus dorsi muscle was selected over the pectoralis major out of concern for potential anterior chest wall deformity when utilizing the pectoralis muscle for transfer.…”

“…We elected to perform a muscle transfer to restore biceps function in the hope that this would not only provide functional improvement but also maintain congruity of the elbow joint. We used a latissimus dorsi muscle transfer as has been described by others for restoration of elbow flexion [27,42,50,54,62]. Surgical exploration of the upper arm to define the pathology was necessary to inset the musculocutaneous flap, and therefore, further diagnostic tests were felt to be unnecessary.…”

Bipolar latissimus transfer for restoration of elbow flexion

“…We harvest the entire muscle to maximize power, however transplantation of only the lateral half when the latissimus is bulky has been described. 26 Next, a deltopectoral approach is utilized for proximal reattachment of the insertion. Both superior and inferior borders of the pectoralis major are developed until the deep surface is cleared.…”

“…5 Some employ functional latissimus training 2e3 months preoperatively to "re-educate" the muscle until resisted adduction is achieved. 25,26 The idiom of donor muscles needing at least grade 4/5 power to withstand losing one grade after transfer is not applicable in this case, as the goal is to maintain Grade 4/5 power despite an expected loss of strength.…”