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J Hand Microsurg 2023; 15(03): 203-211
DOI: 10.1055/s-0041-1739962
Original Article

Unipolar Latissimus Dorsi Transfer for Restoration of Elbow Flexion in Residual Post-traumatic Brachial Plexus Palsy Associated with Distal Humeral Fractures

Ahmed Fathy Sadek
1   Hand and Microsurgery Unit, Orthopaedic Surgery Department, Faculty of Medicine, Minia University, Minia, Egypt
,
Mohamed A. Ellabban
2   Plastic and Reconstructive Surgery Unit, Suez Canal University Hospitals and Medical School, Ismailia, Egypt
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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.

Keywords

latissimus dorsi - restoration of elbow flexion - residual brachial plexus palsy - distal humeral fracture

Authors' Contribution

A.F.S. and M.A.E. actively and evenly participated in the following: performing the surgical procedures, clinical and radiological evaluations of the patients and preparing the manuscript. A.F.S. has made the final manuscript edition.


Ethical Committee Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. A retrospective comparative two center study was conducted after obtaining the approval of the human ethical committees of the two institutions involved (No: 140–12/2018).


Informed Consent

A full informed written consent has been obtained from all patients reviewed for this study including full awareness and knowledge of the nature of the study, the possible submission to interviews, clinical evaluation, or any other assessment tool.




Publication History

Article published online:
01 December 2021

© 2021. Society of Indian Hand Surgery & Microsurgeons. All rights reserved.

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  • References

  • 1 Chaudhry S, Hopyan S. Bipolar latissimus transfer for restoration of elbow flexion. J Orthop 2013; 10 (03) 133-138
    CrossrefPubMedGoogle Scholar
  • 2 Vekris MD, Beris AE, Lykissas MG, Korompilias AV, Vekris AD, Soucacos PN. Restoration of elbow function in severe brachial plexus paralysis via muscle transfers. Injury 2008; 39 (Suppl. 03) S15-S22
    CrossrefPubMedGoogle Scholar
  • 3 Millesi H. Interfascicular grafts for repair of peripheral nerves of the upper extremity. Orthop Clin North Am 1977; 8 (02) 387-404
    CrossrefPubMedGoogle Scholar
  • 4 Nagano A, Tsuyama N, Ochiai N, Hara T, Takahashi M. Direct nerve crossing with the intercostal nerve to treat avulsion injuries of the brachial plexus. J Hand Surg Am 1989; 14 (06) 980-985
    CrossrefPubMedGoogle Scholar
  • 5 Samii M, Carvalho GA, Nikkhah G, Penkert G. Surgical reconstruction of the musculocutaneous nerve in traumatic brachial plexus injuries. J Neurosurg 1997; 87 (06) 881-886
    CrossrefPubMedGoogle Scholar
  • 6 Agrawal NK, Choudhary AN, Agrawal P. Unipolar pedicled latissimus dorsi transfer for elbow reanimation in traumatic brachial plexus injuries. Int J Res Med Sci 2020; 8: 387-395
    CrossrefPubMedGoogle Scholar
  • 7 Kawamura K, Yajima H, Tomita Y, Kobata Y, Shigematsu K, Takakura Y. Restoration of elbow function with pedicled latissimus dorsi myocutaneous flap transfer. J Shoulder Elbow Surg 2007; 16 (01) 84-90
    CrossrefPubMedGoogle Scholar
  • 8 Stevanovic MV, Cuéllar VG, Ghiassi A, Sharpe F. Single-stage reconstruction of elbow flexion associated with massive soft-tissue defect using the latissimus dorsi muscle bipolar rotational transfer. Plast Reconstr Surg Glob Open 2016; 4 (09) e1066
    CrossrefPubMedGoogle Scholar
  • 9 Sood A, Therattil PJ, Russo G, Lee ES. Functional latissimus dorsi transfer for upper-extremity reconstruction: a case report and review of the literature. Eplasty 2017; 17: e5
    PubMedGoogle Scholar
  • 10 Azab AA, Alsabbahi MS. Bipolar transfer of latissimus dorsi myocutaneous flap for restoration of elbow flexion in late traumatic brachial plexus injury: evaluation of 13 cases. Ann Plast Surg 2017; 78 (02) 198-201
    CrossrefPubMedGoogle Scholar
  • 11 Steindler A. Tendon transplantation in the upper extremity. Am J Surg 1939; 44: 260-271
    CrossrefPubMedGoogle Scholar
  • 12 Eggers IM, Mennen U, Matime AM. Elbow flexorplasty: a comparison between latissimus dorsi transfer and Steindler flexorplasty. J Hand Surg [Br] 1992; 17 (05) 522-525
    CrossrefPubMedGoogle Scholar
  • 13 De Smet L. Bipolar latissimus dorsi flap transfer for reconstruction of the deltoid. Acta Orthop Belg 2009; 75 (01) 32-36
    PubMedGoogle Scholar
  • 14 Ihara K, Katsube K, Misumi H, Kawai S. Successful restoration of the trapezius muscle using pedicle latissimus dorsi. A case report. Clin Orthop Relat Res 2000; (371) 125-130
    CrossrefPubMedGoogle Scholar
  • 15 Jones BN, Manske PR, Schoenecker PL, Dailey L. Latissimus dorsi transfer to restore elbow extension in obstetrical palsy. J Pediatr Orthop 1985; 5 (03) 287-289
    CrossrefPubMedGoogle Scholar
  • 16 Moursy M, Cafaltzis K, Eisermann S, Lehmann LJ. Latissimus dorsi transfer: L'Episcopo versus Herzberg technique. Acta Orthop Belg 2012; 78 (03) 296-303
    PubMedGoogle Scholar
  • 17 Morrey BF, An KN. Functional evaluation of the elbow. In: Morrey BF. ed. The elbow and Its Disorders. 3rd ed.. Philadelphia: WB Saunders; 2000: 82
    Google Scholar
  • 18 Takahashi M, Kasai T, Hibino N, Ishii S, Mitsuhashi T. Pedicled unipolar latissimus dorsi flap for reconstruction of finger extensor. Case Reports Plast Surg Hand Surg 2017; 4 (01) 30-34
    CrossrefPubMedGoogle Scholar
  • 19 Jutte DL, Rees R, Nanney L, Bueno R, Lynch JB. Latissimus dorsi flap: a valuable resource in lower arm reconstruction. South Med J 1987; 80 (01) 37-40
    CrossrefPubMedGoogle Scholar
  • 20 Berger A, Brenner P. Secondary surgery following brachial plexus injuries. Microsurgery 1995; 16 (01) 43-47
    CrossrefPubMedGoogle Scholar
  • 21 Cambon-Binder A, Belkheyar Z, Durand S, Rantissi M, Oberlin C. Elbow flexion restoration using pedicled latissimus dorsi transfer in seven cases. Chir Main 2012; 31 (06) 324-330
    CrossrefPubMedGoogle Scholar
  • 22 Chen WS. Restoration of elbow flexion by latissimus dorsi myocutaneous or muscle flap. Arch Orthop Trauma Surg 1990; 109 (03) 117-120
    CrossrefPubMedGoogle Scholar
  • 23 Kameda T, Soichi E, Yokota T, Konno S-I. Restoration of elbow flexion with a pedicled latissimus dorsi myocutaneous flap to a brachial plexus injury at the terminal nerve level. Plast Reconstr Surg Glob Open 2019; 7 (10) e2472
    CrossrefPubMedGoogle Scholar
  • 24 Moneim MS, Omer GE. Latissimus dorsi muscle transfer for restoration of elbow flexion after brachial plexus disruption. J Hand Surg Am 1986; 11 (01) 135-139
    CrossrefPubMedGoogle Scholar