title: Functional Latissimus Dorsi Transfer for Upper-Extremity Reconstruction: A Case Report and Review of the Literature.
abstract: Objective:The latissimus dorsi flap is a workhorse for plastic surgeons, being used for many years for soft-tissue coverage of the upper extremity as well as for functional reconstruction to restore motion to the elbow and shoulder. The authors present a case of functional latissimus dorsi transfer for restoration of elbow flexion and review the literature on technique and outcomes.Methods:A literature review was performed using MEDLINE and the Cochrane Collaboration Library for primary research articles on functional latissimus dorsi flap transfer. Data related to surgical techniques and outcomes were extracted.Results:The literature search yielded 13 relevant studies, with a total of 52 patients who received pedicled, functional latissimus dorsi flaps for upper-extremity reconstruction. The most common etiology requiring reconstruction was closed brachial plexus injury (n = 13). After flap transfer, 98% of patients were able to flex the elbow against gravity and 82.3% were able to flex against resistance. In the presented case, a 77-year-old man underwent resection of myxofibrosarcoma of the upper arm with elbow prosthesis placement and functional latissimus dorsi transfer. The patient was able to actively flex against gravity at 3-month follow-up.Conclusions:A review of the literature shows that nearly all patients undergoing functional latissimus dorsi transfer for upper-extremity reconstruction regain at least motion against gravity whereas a large proportion regain motion against resistance. Considerations when planning for functional latissimus dorsi transfer include patient positioning, appropriate tensioning of the muscle, safe inset, polarity, management of other affected upper-extremity joints, and educating patients on the expected outcomes.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark.
authors.forename: Aditya
authors.initials: A
authors.lastname: Sood
authors.affiliation: Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Therattil
authors.affiliation: Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Russo
authors.affiliation: Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark.
authors.forename: Edward S
authors.initials: ES
authors.lastname: Lee
keywords: elbow flexion; flap reconstruction; functional muscle transfer; latissimus dorsi flap; upper-extremity reconstruction