Modification of the L'Episcopo procedure for brachial plexus birth palsies

Abstract

We reviewed 19 children who had undergone a new modification of the L'Episcopo procedure for obstetric brachial plexus palsy. Through an axillary approach the latissimus dorsi tendon was rerouted anteriorly to the humerus and then anastomosed to the teres major tendon routed posteriorly. At an average follow-up of four years two months, the mean increase in shoulder abduction was 26 and the mean increase in external rotation was 29#{176}. No neurovascular injury or postoperative infection occurred. Two patients had complications, and five did not gain from the procedure.

Reverse Shoulder Arthroplasty Combined with a Modified Latissimus Dorsi and Teres Major Tendon Transfer for Shoulder Pseudoparalysis Associated with Dropping Arm

“…The combined RSA and tendon transfer is performed in the same operative session through a single deltopectoral approach with the patient in the beach chair position, obviating the need to place the patient in the lateral position and another posterior approach to harvest the tendons [12,13,15,28,31,38,40,49]. The deltopectoral approach makes the identification, dissection, and transfer of the LD/ TM tendons relatively simple and safe, because the tendons are located at the medial border of the humerus immediately behind the pectoralis major tendon.…”

“…1). Although external rotation deficit can be successfully treated with a tendon transfer, such a muscle transfer alone may be inadequate to power external rotation and elevation with such global dysfunction, and is contraindicated when arthritic changes are present [12,13,15,20,28,31,38,40,49].…”

Results of Sever- L’ Episcopo procedure for obstetric brachial plexus palsy

“…The mean external rotation in the Strecker et al series was 78 degrees and in that of Covey et al was 29 degrees. 8,9 Also it was very difficult to objectively compare the results in literature as each author has adopted some slight modifications from the classical Sever-L' Episcopo tendon transfer as like in Strecker's series where he has sutured the tendons of Lattismus dorsi and Teres major to the posterior fibres of the Deltoid hoping to improve the abduction as well apart from external rotation.…”

Bidirectional Double Muscle Transfer to Restore Shoulder Abduction and External Rotation in Late Obstetric Brachial Plexus Injuries

“…It is logic to use the procedure of muscle release and transfer before evident dysplasia of GH joint that usually happened at age of 3 or 4 year [17].…”