Elbow flexion restoration using pedicled latissimus dorsi transfer in seven cases

Bipolar latissimus transfer for restoration of elbow flexion

“…An overall 75% rate of achieving elbow flexion against resistance is reported. 5 Flexion power averages 2e3 kg through a 90e140 degrees arc. 2,5,7,23,28,30 …”

“…Alternatively, distal fixation can be performed to the radial tuberosity 1 or proximal third of the ulnar diaphysis to increase the lever arm and improve strength, mimicking the ulnar insertion of the brachialis. 5 The resting tension of the repair should be about 100 degrees of flexion and maximum supination to optimize muscle strength along its Blix curve. Repair is reinforced with sutures across the tendon junction or hardware in the case of bony fixation.…”

“…Spontaneously resolving hematoma, fibrofatty latissimus degeneration, loss of muscle tension requiring shortening, progressive myelopathy compromising the thoracodorsal nerve, 25 antagonistic co-contraction of the triceps resolving with botox injection, 5 and necrosis from a thrombosed pedicle, 28 and have each been described once. Skin necrosis and infection at the elbow site occurred in 2 of 21 various types of latissimus transfers, however both involved prior scarring and splinted in 150 degrees of flexion postoperatively.…”

“…3 Bipolar transfer is advantageous in that proximal fixation near the coracoid stabilizes the anterior shoulder joint while concomitantly improving arm flexion in a direct line of pull. 4,5 The latissimus was chosen for its long pedicle, easily contoured shape, and minimal donor morbidity. These favorable characteristics have lead to its use for other reconstructions including triceps, 6 trapezius, 7 and deltoid, 8 and most commonly irreparable rotator cuff tears.…”

“…Equivocal clinical exams can be supplemented with nerve conduction studies or intraoperative electrical stimulation to further evaluate contractility, though decision on transferability should be made on preoperative manual motor testing. 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.…”