A review of functional latissimus dorsi transfers for absent elbow flexion and supination

Abstract

Aims To review patients treated with a functional latissimus dorsi flap for congenital and acquired elbow flexion deficits. Methods Retrospective review of functional latissimus dorsi flaps performed in one regional unit. Patient notes were reviewed to determine aetiology, pre-op deficits and function, surgical technique, complications and outcomes. Results A total of six functional latissimus dorsi transfers were performed on four patients. Two patients had bilateral latissimus dorsi transfers for congenital defects. The remaining two procedures were for traumatic defects. Post-operatively both children had excellent outcomes with full range of active movement allowing them to perform key activities of daily living. Surgical Technique Epimysium of latissimus dorsi folded to form a pseudo-tendon, tunnelled subcutaneously and either attached to a remnant of biceps tendon or secured to the radius. Congenital patients achieved better outcomes; pre-operatively, there was no active elbow flexion in all four elbows but 90–100 of passive flexion. Complications One latissimus dorsi dehiscence which required revision surgery. Two donor-site seromas. Conclusions Functional latissimus dorsi transfer has been shown to achieve excellent elbow flexion in patients with congenital absence of biceps and brachialis muscles. Outcomes in older patients with traumatic injuries have been less successful in achieving a full range of active flexion.