title: Single-stage Reconstruction of Elbow Flexion Associated with Massive Soft-Tissue Defect Using the Latissimus Dorsi Muscle Bipolar Rotational Transfer.
abstract: In the upper extremity, the latissimus dorsi muscle can be used as an ipsilateral rotational muscle flap for soft-tissue coverage or functional reconstruction of arm and elbow. Patients who have both major soft-tissue loss and functional deficits can be successfully treated with a single-stage functional latissimus dorsi rotational muscle transfer that provides simultaneous soft-tissue coverage and functional reconstruction.
  
  
  METHODS
  Our data base was queried for all patients undergoing a rotational latissimus dorsi muscle transfer for simultaneous soft-tissue coverage and functional reconstruction of elbow flexion. Four patients were identified. A chart review documented the mechanism of injury, associated injuries, soft-tissue defect size, number of surgical procedures, length of follow-up, last elbow range of motion, and flexion strength.
  
  
  RESULTS
  Four patients with loss of elbow flexion due to traumatic loss of the anterior compartment muscles and the overlying soft tissue underwent simultaneous soft-tissue coverage and elbow flexorplasty using the ipsilateral latissimus dorsi as a bipolar muscle rotational tissue transfer. All flaps survived and had a recovery of Medical Research Council Grade 4/5 elbow flexion strength. No additional procedures were required for elbow flexion. The surgical technique is described and supplemented with surgical technique video and patient outcome.
  
  
  CONCLUSIONS
  This patient series augments the data provided in other series supporting the safety and efficacy of this procedure which provides both soft-tissue coverage and functional restoration of elbow flexion as a single-stage procedure in the setting of massive traumatic soft-tissue loss of the arm.
authors.affiliation: Division of Hand and Microsurgery, Department of Orthopaedics, University of Southern California and Los Angeles County Medical Center, Los Angeles, Calif.; and Department of Orthopedics, Southern California Permanente Medical Group, Fontana, Calif.
authors.forename: Milan V
authors.initials: MV
authors.lastname: Stevanovic
authors.affiliation: Division of Hand and Microsurgery, Department of Orthopaedics, University of Southern California and Los Angeles County Medical Center, Los Angeles, Calif.; and Department of Orthopedics, Southern California Permanente Medical Group, Fontana, Calif.
authors.forename: Vanessa G
authors.initials: VG
authors.lastname: Cuéllar
authors.affiliation: Division of Hand and Microsurgery, Department of Orthopaedics, University of Southern California and Los Angeles County Medical Center, Los Angeles, Calif.; and Department of Orthopedics, Southern California Permanente Medical Group, Fontana, Calif.
authors.forename: Alidad
authors.initials: A
authors.lastname: Ghiassi
authors.affiliation: Division of Hand and Microsurgery, Department of Orthopaedics, University of Southern California and Los Angeles County Medical Center, Los Angeles, Calif.; and Department of Orthopedics, Southern California Permanente Medical Group, Fontana, Calif.
authors.forename: Frances
authors.initials: F
authors.lastname: Sharpe