title: Assessment of long-term donor-site morbidity after harvesting the latissimus dorsi flap for neonatal myelomeningocele repair.
abstract: OBJECTIVE
  The latissimus dorsi flap (LDF) has been employed very successfully over decades to cover large soft-tissue defects. Its donor-site morbidity has been extensively investigated in adults - but not in children - and is considered to be nonrestrictive. The aim of this long-term study was to assess donor-site morbidity with the modified Constant score more than 8 years after coverage of large myelomeningocele (MMC) defects with a reverse latissimus dorsi flap.
  
  
  METHODS
  Within the first days after birth, the reverse latissimus dorsi muscle flap was used uni- or bilaterally in three neonates to cover a large MMC defect. Bilateral shoulder function was tested more than 8 years postoperatively according to the modified Constant score.
  
  
  RESULTS
  The mean age at follow-up was 11.7 years. None of the patients experienced any pain or shoulder restrictions during normal daily activities. They all managed to position both of their arms comfortably above the head. Forward flexion was normal in all patients as was abduction and external rotation. Dorsal extension was minimally reduced on the operated side. Internal rotation was symmetric in all patients; the extent of active movement varied from excellent to poor.
  
  
  CONCLUSIONS
  Our long-term data suggest that there is no specific and significant impairment of shoulder function after using the distally pedicled reverse LDF for neonatal MMC repair.
authors.affiliation: Clinic of Hand, Reconstructive and Plastic Surgery, Kantonsspital Aarau, Aarau, Switzerland. Electronic address: Rikthedutch@mac.com.
authors.forename: R
authors.initials: R
authors.lastname: Osinga
authors.affiliation: Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Mazzone
authors.affiliation: Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Meuli
authors.affiliation: Clinic of Hand, Reconstructive and Plastic Surgery, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Meuli-Simmen
authors.affiliation: Clinic of Hand, Reconstructive and Plastic Surgery, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: von Campe
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008591:Meningomyelocele / Q000601:surgery; D009068:Movement / Q000502:physiology*; D053580:Muscle Strength / Q000502:physiology; D012399:Rotation; D012782:Shoulder / Q000502:physiology*; D064171:Superficial Back Muscles / Q000637:transplantation*; D013524:Surgical Flaps; D060053:Transplant Donor Site
keywords: Functional outcome; Latissimus dorsi flap; Long-term follow-up; Myelomeningocele; Spina bifida