Bipolar Transfer of Latissimus Dorsi Myocutaneous Flap for Restoration of Elbow Flexion in Late Traumatic Brachial Plexus Injury

Azab, Ahmed; Alsabbahi, Mohammad Salah

doi:10.1097/sap.0000000000000907

Cited by 15 publications

(18 citation statements)

References 15 publications

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“…23 In a case series incorporating 13 patients who were subjected to BLDT for restoration of elbow flexion following late brachial plexus injuries, 11 patients achieved grades 3 and 4 on BMRC grading. 10 The flexion contracture in this study averaged 10 degrees which was better than other studies which approached ≥ 20 degrees. 10 This degree of flexion contracture did not jeopardize the final functional outcome, on the contrary, this was beneficial to facilitate initiation of elbow flexion.…”

Section: Discussioncontrasting

confidence: 59%

Unipolar Latissimus Dorsi Transfer for Restoration of Elbow Flexion in Residual Post-traumatic Brachial Plexus Palsy Associated with Distal Humeral Fractures

Sadek

Ellabban

2023

Journal of Hand and Microsurgery

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Introduction Elbow flexion is indispensable for both functioning and nonfunctioning hands. It is well perceived that restoration of elbow function is the first reconstructive priority in cases of brachial plexus injuries. The authors assessed the impact of associated distal humeral fractures on the functional outcome after unipolar latissimus dorsi transfer (ULDT) for restoration of elbow flexion in patients with residual brachial plexus palsy (BPP). Patients and Methods Twenty-three patients operated for restoring elbow flexion after residual post-traumatic BPP (with or without distal humeral fracture) by unipolar latissimus dorsi transfer (ULDT) were reviewed for a retrospective study. Patients were divided into two groups; associated distal humeral fracture group (HF-group; 10 patients) and non-associated distal humeral fracture group (NHF-group; 13 patients). Elbow flexion active range of motion (AROM), flexion deformity in addition to Mayo Elbow Performance Score (MEPS) were assessed. Results In both groups there were statistically better postoperative MEPS grading (p = 0.007, p = 0.001, respectively) and scoring with a mean of 81 ± 16.1 and 90 ± 4.6, respectively (p < 0.001). The mean postoperative elbow flexion AROM was statistically better in both groups. The mean supination AROM was better in NHF group (p = 0.057). Conclusion The use of ULDT in residual post-traumatic BPP is an efficient procedure in regaining functional flexion and supination. An associated distal humeral fracture does not significantly affect the final functional outcome. Level of Evidence Level IV.

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Section: Discussioncontrasting

confidence: 59%

Unipolar Latissimus Dorsi Transfer for Restoration of Elbow Flexion in Residual Post-traumatic Brachial Plexus Palsy Associated with Distal Humeral Fractures

Sadek

Ellabban

2023

Journal of Hand and Microsurgery

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“…Since the development of this surgical technique, the outcomes have been variable, and it has been noted that preoperative assessment of the LD muscle plays a significant role in prognosis [ 22 ]. Many surgeons used this technique to restore elbow flexion, considering evaluating the LD muscle before surgery, and most of them reported a good result in active ROM [ 23 , 24 ]. Harvesting the flap with a skin paddle will allow for flap monitoring postoperatively [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Elbow Flexion Reconstruction Using Latissimus Dorsi Muscle Transfer Following a Road Traffic Accident and Upper Limb Trauma

et al. 2021

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Patient: Male, 30-year-old Final Diagnosis: Biceps brachii muscle necrosis Symptoms: Impaired elbow flexion Medication:— Clinical Procedure: — Specialty: Orthopedics and Traumatology • Plastic Surgery Objective: Rare disease Background: Several surgical procedures to restore elbow flexion have been reported in the literature. Multiple factors direct the selection of appropriate procedures for each patient, including hand dominance, neurovascular injury, and comorbidities. Traumatic damage to the anterior compartment of the arm is an indication for latissimus dorsi transfer, which can restore elbow flexion. Bipolar pedicled latissimus dorsi (LD) flap is a design used very rarely to simultaneously reconstruct biceps brachii soft-tissue defects and regain complete flexion function. We report the case of a 30-year-old man who underwent successful elbow flexion reconstruction using latissimus dorsi muscle transfer following a road traffic accident and upper limb trauma. Case Report: A 30-year-old man presented with acute compartment syndrome caused by a road traffic accident and impact trauma to the left arm. The surgical evaluation revealed proximal biceps tendons rapture; therefore, immediate repair and therapeutic fasciotomy were done. Subsequently, unsuccessful repair resulted in total necrosis of the biceps muscle, which necessitated debridement of the biceps muscle. Delayed reconstruction with an LD flap was successfully done after stabilization of the patient’s condition. The flap was harvested as free-pedicled, then modified into a tube-like shape to resemble the biceps muscle. Conclusions: This report has shown that the surgical procedure of latissimus dorsi muscle transfer can successfully restore elbow function following upper limb trauma; however, preoperative planning and postoperative follow-up are crucial for functional reconstruction of the upper extremity. In addition, carefully selecting reconstructive surgery considering patient factors, degree of injury, and the institution’s capacity are essential factors in achieving optimal function restoration with minimal complications.

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“…These add microsurgery sutures for the nerve, artery, and veins. With a pedicled transfer of the latissimus dorsi, 85% of patients scored elbow flexion strengths of MRC 3-4, with little morbidity 3,9,12 . This alternative does not require resorting to microsurgical neurovascular techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Loss of elbow flexion leads to significant limitation of patient autonomy and their ability to work. The various options for flexion reanimation include nerve grafts, nerve transfers 18 , and muscle transfers 3 . The technique that is used depends on a variety of factors such as the palsy's etiology, the delay in performing the surgery, and the patient's surgical history.…”

Section: Introductionmentioning

confidence: 99%

Bipolar transfer of the pectoralis major muscle for restoration of elbow flexion in 29 cases

Walch

Marcheix

Belkheyar

2018

Journal of Shoulder and Elbow Surgery

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The aim of this study was to evaluate the functional outcomes of bipolar pedicled pectoralis major (PM) transfer to restore elbow flexion. Methods We retrospectively reviewed 29 transfers in 28 patients who ranged from 5 to 65 years of age (mean age of 31.2 years.). The loss of elbow flexion was due to brachial plexus palsy for 24 patients, elbow flexors necrosis in four and poliomyelitis in one patient. The whole PM muscle was mobilized and fixed proximally to the coracoid process. Intraoperative positioning and postoperative immobilization of the shoulder and the elbow flexed at 60° and 120° respectively, allowed direct distal fixation of the muscle to the biceps brachii tendon. Results Pectoralis major transfer in 29 cases 2 At the last follow-up (mean of 13 months, ranging from 4 to months), 41% of the transfers (n=12) recovered grade-4 elbow flexion strength and were able to lift 2.2 kg on average (ranging from 0.5 to 5 kg). Fifty-two per cent of the patients (n=15) recovered grade-3 strength, and 7% (n=2) had a poor result (i.e. grade-2 elbow flexion). The mean active elbow flexion was 100° (ranging from 30 to 150°) and the patients had 0 to 10° elbow flexion contracture. Discussion-Conclusion Our results indicate that bipolar PM transfer is a reliable and effective procedure to restore elbow flexion. Flexion of the shoulder and elbow allowed the transfer to reach the elbow fold, and avoided having to resort to use of an interposition graft between the distal PM and the biceps brachii tendon.

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Bipolar Transfer of Latissimus Dorsi Myocutaneous Flap for Restoration of Elbow Flexion in Late Traumatic Brachial Plexus Injury

Abstract: Bipolar transfer of latissimus dorsi myocutaneous flap is a reliable method for restoration of elbow flexion in patients suffering from late sequelae of traumatic brachial plexus injury.

Cited by 15 publications

References 15 publications

Unipolar Latissimus Dorsi Transfer for Restoration of Elbow Flexion in Residual Post-traumatic Brachial Plexus Palsy Associated with Distal Humeral Fractures

Unipolar Latissimus Dorsi Transfer for Restoration of Elbow Flexion in Residual Post-traumatic Brachial Plexus Palsy Associated with Distal Humeral Fractures

Successful Elbow Flexion Reconstruction Using Latissimus Dorsi Muscle Transfer Following a Road Traffic Accident and Upper Limb Trauma

Bipolar transfer of the pectoralis major muscle for restoration of elbow flexion in 29 cases

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