Successful Restoration of Elbow Extension Using the Latissimus Dorsi Flap: Case Report

Abstract

Summary: The latissimus dorsi (LD) myocutaneous flap is heavily used in reconstructive plastic surgery as either a local or distant flap, and mostly for coverage of large defects. To date, only a limited number of studies have described the use of an LD flap for functional reconstruction. Restoration of the extensor mechanism remains an unexplored area, and several issues remain to be addressed. First, generally accepted recommendations for the surgical technique do not include specific steps to achieve functional qualities of the upper extremity after complete removal of the triceps brachii muscle. Second, to date, it has not been clarified whether elbow extension requires correction because the movement can be naturally compensated for by gravity. To contribute to the current knowledge base in this field, the authors describe a technique for the reconstruction of an extensor mechanism of the elbow by transferring a pedicled functional LD flap while maintaining an intact insertion. Reconstruction was performed in a patient who experienced a second recurrence of a malignant peripheral nerve sheath tumor and underwent complete excision of the triceps brachii muscle. After excision, a meshed epidermal graft was used for wound closure. The patient’s postoperative course was uneventful. His elbow was immobilized for 3 weeks using an elbow splint, followed by intensive rehabilitation. The functional result was excellent, with an Enneking limb function score of 26. During the 16-month follow-up, no signs of local recurrence or systemic spread were observed.