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Kobayashi Y, Uchiyama Y, Yoshida S, Saito I, Ishii T, Nakajima D, Yanagisawa S, Watanabe M. Functional reconstruction of elbow flexion with latissimus dorsi muscle rotational transfer: two case reports. J Med Case Rep 2023; 17:454. [PMID: 37904251 PMCID: PMC10617077 DOI: 10.1186/s13256-023-04178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/13/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND We report two cases of biceps brachii and brachialis paralysis due to musculocutaneous nerve injury in which elbow joint flexion was reconstructed using rotational transfer of the latissimus dorsi muscle with sutures to the radial and ulnar tuberosities, thereby enabling flexion by simultaneous activation of the humeroradial and humeroulnar joints. In cases of associated brachialis paralysis, weaker flexion strength can be expected when the forearm is in a pronated position than when it is in a supinated state. To the best of our knowledge, no previous study has reported the rotational position of the forearm during elbow joint flexion reconstruction. CASE PRESENTATION Case 1 involved a 30-year-old Asian male who presented with a rupture of the musculocutaneous, median, radial, and ulnar nerves. Reconstruction was performed by rotational transfer of the latissimus dorsi muscle. In this case, the supination and pronation flexion forces were equal. Case 2 involved a 50-year-old Asian man who presented with partial loss of the musculocutaneous nerve, biceps brachii, and pectoralis major due to debridement. Reconstruction was performed by rotational transfer of the latissimus dorsi muscle. In this case, supination and pronation flexion strengths were demonstrated to be equal. Our reconstruction method used the rotational transfer of the latissimus dorsi muscle; the distal muscle flap was divided into radial and ulnar sides to allow elbow joint flexion by simultaneously activating the humeroradial and humeroulnar joints. These sides were then fixed to the anchors at the radial and ulnar tuberosities. Finally, they were wrapped around the myotendinous junction of the biceps brachii or brachialis and secured using sutures. CONCLUSIONS Although larger studies are required to verify these methods, this case study successfully demonstrates the following: (1) the flexion strength in the supinated position was equal to that in the pronated position; (2) the stability of the humeroradial and humeroulnar joints was unaffected by the forearm's rotational position; and (3) a satisfactory range of motion of the elbow joint was obtained, with no complications.
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Affiliation(s)
- Yuka Kobayashi
- Department of Orthopaedic Surgery, Tokai University Hachioji Hospital, Ishikawacho, Hachioji, Tokyo, 192-0032, Japan.
| | - Yoshiyasu Uchiyama
- Department of Orthopaedic Surgery, Tokai University Hachioji Hospital, Ishikawacho, Hachioji, Tokyo, 192-0032, Japan
| | - Shinji Yoshida
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, 259‑1193, Japan
| | - Ikuo Saito
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, 259‑1193, Japan
- Department of Orthopaedic Surgery, Isehara Kyodo Hospital, Kanagawa, 259-1187, Japan
| | - Takayuki Ishii
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, 259‑1193, Japan
| | - Daisuke Nakajima
- Department of Orthopaedic Surgery, Tokai University Hachioji Hospital, Ishikawacho, Hachioji, Tokyo, 192-0032, Japan
| | - Shou Yanagisawa
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, 259‑1193, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, 259‑1193, Japan
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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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Sadek AF, Ellabban MA. Unipolar Latissimus Dorsi Transfer for Restoration of Elbow Flexion in Residual Post-traumatic Brachial Plexus Palsy Associated with Distal Humeral Fractures. J Hand Microsurg 2021. [DOI: 10.1055/s-0041-1739962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
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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Affiliation(s)
- Ahmed Fathy Sadek
- Hand and Microsurgery Unit, Orthopaedic Surgery Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mohamed A. Ellabban
- Plastic and Reconstructive Surgery Unit, Suez Canal University Hospitals and Medical School, Ismailia, Egypt
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Alshammari SM, Alghamdi AA, Almarzouq SF, Shash HA. Successful Elbow Flexion Reconstruction Using Latissimus Dorsi Muscle Transfer Following a Road Traffic Accident and Upper Limb Trauma. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933374. [PMID: 34686648 PMCID: PMC8552418 DOI: 10.12659/ajcr.933374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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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Affiliation(s)
- Salem Mohammad Alshammari
- Department of General Surgery, Plastic and Reconstructive Surgery Unit, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulrahman Abdulaziz Alghamdi
- Department of General Surgery, Plastic and Reconstructive Surgery Unit, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sawsan Fahad Almarzouq
- Department of General Surgery, Plastic and Reconstructive Surgery Unit, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hani Ali Shash
- Department of General Surgery, Plastic and Reconstructive Surgery Unit, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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