The Latissimus Dorsi Muscle Flap Transfer in Surgical Correction of Post-Traumatic Upper Limb Dysfunction

Abstract

Objective: To improve the outcomes of surgical correction of upper limb dysfunction (ULD) using the latissimus dorsi flap (LDF). Methods: ULD occurred in 76 patients with Volkmann's ischemic contracture (VIC), post-traumatic soft tissue defects, and brachial plexitis in 57, 11, and 8 cases, respectively. Out of 57 patients with VIC, in 30 cases, a skin defect was observed along with severe degenerative changes in soft tissues, neurovascular bundles (NVBs) and tendons. Post-traumatic forearm defects (n=11) in 5 cases were accompanied by damage to the NVBs and tendons. In brachial plexitis, isolated injury to the musculocutaneous nerve occurred in 6 patients, and a combination of nerve lesions with radial nerve palsy – in 2 patients. Results: Transposition of LDF to the biceps brachii for the treatment of brachial plexitis, free muscle transplantation for the treatment of VIC and forearm soft tissue defects were performed in 8, 57, and 11 cases, respectively. Active forearm flexion after the muscle flap transposition was noted after 4 weeks. In contrast, after graft transplantation in VIC, the grip function restoration began after 6 months and improved within 1 year and beyond. Conclusion: Using the LDF in surgical correction of post-traumatic ULD allowed restoring the lost functions of the crushing grip and forearm flexion. For the forearm, only free flap transplantation with a relatively long period of limb function recovery is possible. In contrast, the traspositioned LDF to the biceps allows achieving the desired functional outcomes in the shortest possible time. Keywords: Upper limb, latissimus dorsi flap, Volkmann's contracture, soft-tissue defect, brachial plexitis.