Pedicle island flaps of latissimus dorsi. Applications in surgical repair of ruptures of the rotator cuff.
There are considerable problems in repair of major ruptures of the rotator cuff tendons particularly those of the supra and infraspinatus mm. The Gerber technique only transfers the tendinous insertion of the latissimus dorsi onto the greater tuberosity in massive cuff ruptures. We have extended this approach. In 12 shoulders, we studied the feasibility of a latissimus dorsi transfer harvested to fit and bearing muscle and tendon detached at its two extremities and transposed as a neurovascular island. The muscular part is transferred to the infra or supraspinous fossae and the tendon to the greater tuberosity with the aim of reactivating the infra and supraspinatus muscles. The lateral bundle of the latissimus dorsi is always transferable on its neurovascular pedicle into the infraspinous fossa, even into the supraspinous fossa, or into both if transfer is used as a bilobed flap. This anatomical work allowed a parallel study of the different possibilities of transposing the neurovascular pedicle, which might limit the technique, and also to determine the most appropriate surgical approach.
Prud'Homme
M
M
Service d'Orthopédie, Traumatologie, C.H.U, Hôpital de la Cavale Blanche, 29200 Brest, France.
Le Nen
D
D
Lefevre
C
C
Dubrana
F
F
Stindel
E
E
Sénécail
B
B
D000328:Adult; D002102:Cadaver; D004210:Dissection; D005240:Feasibility Studies; D006801:Humans; D010369:Pectoralis Muscles / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012421:Rupture / Q000601:surgery; D012680:Sensitivity and Specificity; D012785:Shoulder Joint / Q000033:anatomy & histology; D013524:Surgical Flaps / Q000098:blood supply; D013709:Tendon Transfer / Q000379:methods*; D020858:Tissue and Organ Harvesting / Q000379:methods