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Türker T, Richard B, Benson V. Long Head of Triceps Tendon Transfer for Agenesis of Biceps and Brachialis: Two Cases. Hand (N Y) 2023; 18:NP6-NP10. [PMID: 36281710 PMCID: PMC10035108 DOI: 10.1177/15589447221128983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Congenital lack of elbow flexion results in significant disability and may be seen in conjunction with syndromes, plexopathies, neuromuscular disorders, or as an isolated muscular agenesis of elbow flexors. There are many tendon transfer options to address this issue, but there is a lack of data on the functional results in the pediatric population. In this series, we present 1 patient with isolated muscular agenesis of the biceps and brachialis musculotendinous units and another with this same muscular agenesis in the setting of arthrogryposis. They were treated with anterior ulnar nerve transposition and transfer of the long head of triceps tendon around 2 years of age resulting in functional elbow flexion in both patients.
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Dabestani PJ, Ramsey MD, Chappell AG, Fracol ME, Stover MD, Ko JH. Free Vascularized Fibular Flap with Bilateral Bipolar Latissimus Transfer for Upper Extremity Reconstruction: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00001. [PMID: 36240298 DOI: 10.2106/jbjs.cc.22.00286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/10/2022] [Indexed: 02/24/2023]
Abstract
CASE A 19-year-old woman presented with bilateral mangled upper extremities after jumping in front of a moving train. After revascularization, osteocutaneous free vascularized fibula flap was performed to reconstruct the right humerus. The left forearm required transradial amputation with acute targeted muscle reinnervation. Finally, staged bilateral bipolar latissimus dorsi functional muscle flaps were performed to restore elbow flexion. CONCLUSION Staged orthoplastic reconstruction of the upper extremities is an effective treatment approach for traumatic bone and soft-tissue defects. This patient's recovery demonstrates improved quality of life after severe upper extremity trauma.
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Affiliation(s)
- Parinaz J Dabestani
- Division of Plastic and Reconstructive Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Matthew D Ramsey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ava G Chappell
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Megan E Fracol
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael D Stover
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jason H Ko
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Catena N, Baldrighi C, Jester A, Soldado F, Farr S. Microsurgery in pediatric upper limb reconstructions: An overview. J Child Orthop 2022; 16:241-255. [PMID: 35992521 PMCID: PMC9382710 DOI: 10.1177/18632521221106390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/13/2022] [Indexed: 02/03/2023] Open
Abstract
The use of microsurgery has spread during the last decades, making resolvable many complex defects considered hitherto inapproachable. Although the small vessel diameter in children was initially considered a technical limitation, the increase in microsurgical expertise over the past three decades allowed us to manage many pediatric conditions by means of free tissue transfers. Pediatric microsurgery has been shown to be feasible, gaining a prominent place in the treatment of children affected by limb malformations, tumors, nerve injuries, and post-traumatic defects. The aim of this current concepts review is to describe the more frequent pediatric upper limb conditions in which the use of microsurgical reconstructions should be considered in the range of treatment options.
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Affiliation(s)
- Nunzio Catena
- Reconstructive Surgery and Hand Surgery
Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy,Nunzio Catena, Reconstructive Surgery and
Hand Surgery Unit, IRCCS Istituto Giannina Gaslini, Largo G. Gaslini 5, 16121
Genova, Italy.
| | - Carla Baldrighi
- Children’s Hand and Upper Limb Service,
Department of Plastic Surgery, Birmingham Children’s Hospital NHS Foundation Trust,
Birmingham, UK
| | - Andrea Jester
- Children’s Hand and Upper Limb Service,
Department of Plastic Surgery, Birmingham Children’s Hospital NHS Foundation Trust,
Birmingham, UK
| | - Francisco Soldado
- Pediatric Hand, Nerve and Microsurgery
Institute, Vall d’Hebron Instituto de Oncologia, Barcelona, Spain
| | - Sebastian Farr
- Pediatric Orthopedics and Foot and
Ankle Surgery, Orthopedic Hospital Speising, Vienna, Austria
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Kwapisz A, Xu M, Koenig J, MacDonald P, McRae S, Marsh J. Uncommon Bilateral Absence of Long Heads of the Biceps Tendons in Twin Sisters: A Report of 2 Cases. JBJS Case Connect 2021; 11:01709767-202109000-00039. [PMID: 34297703 DOI: 10.2106/jbjs.cc.20.00878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
We present 2 cases, 45-year-old identical twin sisters, with bilateral congenital absence of the long head of the biceps tendon (LHBT); 1 twin was symptomatic, while the other was not. Variations of the intra-articular portion of this tendon are widely reported, but there are few reports of cases with absent LHBT. These cases may be of particular interest to radiologists and surgeons because they demonstrate that absent biceps when congenital in nature may not always coincide with symptoms.
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Affiliation(s)
- Adam Kwapisz
- Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
- Clinic of Orthopaedics and Pediatric Orthopaedics, Medical University of Lodz, Lodz, Poland
| | - Mark Xu
- University of Manitoba, Department of Surgery, Winnipeg, Manitoba, Canada
| | - James Koenig
- Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Department of Radiology, Winnipeg, Manitoba, Canada
| | - Peter MacDonald
- Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Department of Surgery, Winnipeg, Manitoba, Canada
| | - Sheila McRae
- Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Department of Surgery, Winnipeg, Manitoba, Canada
| | - Jonathan Marsh
- Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Department of Surgery, Winnipeg, Manitoba, Canada
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Martin S, McBride M, McGarry K, Eames M, Lewis H. A review of functional latissimus dorsi transfers for absent elbow flexion and supination. Shoulder Elbow 2021; 13:329-333. [PMID: 34659474 PMCID: PMC8513000 DOI: 10.1177/1758573219866194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- Serena Martin
- Regional Plastic Surgery Unit, Ulster Hospital, Northern Ireland,Serena Martin, Regional Plastic Surgery Unit, Ulster
Hospital, Northern Ireland.
| | - Michael McBride
- Regional Plastic Surgery Unit, Ulster Hospital, Northern Ireland
| | - Kevin McGarry
- Regional Plastic Surgery Unit, Ulster Hospital, Northern Ireland
| | | | - Harry Lewis
- Regional Plastic Surgery Unit, Ulster Hospital, Northern Ireland
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Zargarbashi R, Nabian MH, Werthel JD, Valenti P. Is bipolar latissimus dorsi transfer a reliable option to restore elbow flexion in children with arthrogryposis? A review of 13 tendon transfers. J Shoulder Elbow Surg 2017; 26:2004-2009. [PMID: 28689830 DOI: 10.1016/j.jse.2017.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/27/2017] [Accepted: 04/16/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Scant data are published about different available therapeutic options for restoration of active elbow flexion in arthrogryposis with varying degrees of improvement. In this retrospective study we evaluated medium-term effects of bipolar latissimus dorsi transfer in patients with arthrogryposis. METHODS Pedicled latissimus dorsi bipolar muscle transfer was used to restore elbow flexion in 11 patients (13 limbs) with arthrogryposis. Elbow and shoulder range of motions and strength of elbow flexion were measured preoperatively and at the last follow-up. The functional use of the upper limb was examined by observation of activities of daily living and presence of adaptive mechanisms. General satisfaction was assessed at the final follow-up. RESULTS The patients were a mean age of 5.69 ± 2.49 years. The follow-up period was 27.31 ± 17.8 months. At the last examination, according to transferred muscle function and elbow range of motion, function of 12 limbs was graded as excellent and good, and 1 was graded poor. The active postoperative elbow range of motion was 97.7° ± 34.5°. The general satisfaction of the patients with the surgical results was 92.3%. Activities of daily living were improved in 10 of 13 limbs, but adaptive mechanisms were detected in all patients except 2 at the last follow-up. CONCLUSIONS We suggest pedicled bipolar latissimus dorsi transfer as a reliable therapeutic option to restore active elbow flexion in arthrogryposis with acceptable results regarding regaining range of motion and patient satisfaction. Functional passive elbow range of motion and good quality of latissimus dorsi muscle preoperatively is mandatory.
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Affiliation(s)
- Ramin Zargarbashi
- Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Philippe Valenti
- Paris Shoulder Unit, Institut de la Main, Clinique Bizet, Paris, France.
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Werthel JD, Zargarbashi R, Valenti P. Radial clubhand with congenital absence of elbow flexors treated by pedicled latissimus dorsi bipolar transfer: report of one case. J Shoulder Elbow Surg 2015; 24:e164-8. [PMID: 25861854 DOI: 10.1016/j.jse.2015.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 01/25/2015] [Accepted: 01/31/2015] [Indexed: 02/01/2023]
Affiliation(s)
- Jean-David Werthel
- Pediatric Orthopedics Division, Chaine de l'Espoir, Paris, France; Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, Paris, France.
| | - Ramin Zargarbashi
- Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Philippe Valenti
- Pediatric Orthopedics Division, Chaine de l'Espoir, Paris, France; Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, Paris, France; Institut de la Main, Centre Orthopédique Jouvenet, Paris, France
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Tibrewal S, Alyas F, Vemulapalli K. Congenital absence of superficial posterior compartment calf muscles. J Orthop Traumatol 2013; 15:137-9. [PMID: 23925689 PMCID: PMC4033818 DOI: 10.1007/s10195-013-0256-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 07/09/2013] [Indexed: 11/23/2022] Open
Abstract
Although various congenital abnormalities have been described, congenital absence of calf musculature is extremely rare, with only one report on its complete absence. We are the first to describe a case of congenital absence of muscles of the superficial posterior compartment of the calf presenting in a toddler. The child presented with a history of a painless limp, however no significant difference was found in functional gait analysis. We suggest that such cases should be monitored and parents can be reassured that no immediate treatment is required.
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Cambon-Binder A, Belkheyar Z, Durand S, Rantissi M, Oberlin C. Elbow flexion restoration using pedicled latissimus dorsi transfer in seven cases. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.main.2012.10.169] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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