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PURPOSE OF THE STUDYLatissimus dorsi transfer is a relatively complicated procedure subsequently requiring an active, long-term physical therapy. The surgeon's performance and a patient's effort are therefore of worth consideration. However, sutures of massive rotator cuff tears do not always produce good results. The aim of the study is to evaluate the role of latissimus dorsi transfer in the treatment of these shoulder pathologies. MATERIALA total of 21 patients were evaluated. Their age at the time of surgery ranged from 48 to 63 years, with an average of 54.8 years. A minimum follow-up was three years, the average was 47 months (70-36 months). The indication for surgery included a massive rotator cuff tear, without symptoms of arthropathy and with normal subscapularis muscle function, which had been resistant to conservative treatment for 6 months at least. In 13 patients, transfer was performed after previous surgery on the rotator cuff. METHODSThe procedure was carried out in a lateral position. The latissimus dorsi tendon was cut off just at its attachment to the humerus, the muscle was mobilised and the musculo-tendinous flap was released to reach the proximal operative wound and to cover the greater tuberosity of the proximal humerus. A shoulder abduction splint was used to immobilise the upper extremity for 6 weeks. Active and supervised individual physical therapy followed. RESULTSSubjective evaluation was excellent in 10, good in 9, and poor in 2 patients. The average Constant-Murley score improved by 32.25 points as compared before surgery (from 38.50 to 70.75). The evaluation of active arm elevation in the frontal plane showed improvement in 16 patients (77 %) by 40° on average, no change in five patients (23 %), and no deterioration in any of the patients. Active external rotation with the arm held at the body side improved by 14° on average. Progression of radiographic changes indicating arthropathy was recorded in five patients. Post-operative haematoma, developed three patients it was treated by needle aspiration in one, and drainage in two patients. DISCUSIONThe results presented here are in agreement with those reported in the international literature. The method of latissimus dorsi transfer shows poorer outcomes after previous attempts to suture of massive rotator cuff tears. In patients with a restricted range of motion before surgery, the post-operative shoulder motion achieved at the final evaluation is also lower. CONCLUSIONSWhen based on a correct indication, latissimus dorsi transfer with an uncomplicated post-operative therapy will result in improvement of shoulder function and pain relief, and it is therefore justified. One of the prerequisites for good results is the initial patient's consent with a supervised, active and long-term post-operative physical therapy. The transfer itself is a demanding surgical procedure associated with several risks and it should therefore be performed by an experienced and competent surgeon with a deep knowledge of shoulder girdle anatomy.

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Introduction: Bleeding from epidural blood vessels may be an unpleasant complication during surgery of the lumbar spine, which is often difficult to manage with electrocoagulation. The use of local hemostatic agents is a possible solution. This paper presents the first experience with an agent of oxidized non-regenerated cellulose. Methods: The agent of oxidized non-regenerated cellulose was used in 21 patients (12 women and 9 men) to stop bleeding from the ventral epi- dural lumbar venous plexus. It was always removed before the end of the operation. Results: In all cases, bleeding was stopped within 2 minutes. Bleeding did not recur until the end of surgery (even after removal of the agent). No early or other complications were observed in the patients studied. Conclusion: The agent of oxidized non-regenerated cellulose appears to be a rational and effective solution for bleeding from epidural veins in the lumbar spine.