Transfer of Middle and Posterior Deltoid Extended by the Lateral Intermuscular Septum for Elbow Extension Reconstruction.

Abstract

Restoring elbow extension in tetraplegia and brachial plexus injuries is critical for improving hand function. In chronic lesions, the traditional method is based on the transfer of the posterior deltoid elongated by a tendon graft to the triceps. Tendon grafts need a prolonged immobilization period to avoid stretching at the muscle-tendon junction. To avoid the use of tendon grafts, we propose harvesting the middle and posterior deltoid muscle along with the entire length of the lateral intermuscular septum, facilitating direct suturing to the triceps tendon. Before surgery, the feasibility of this technique was analyzed in six fresh cadavers. From March 2021 to July 2024, we performed this muscle transfer on 12 upper limbs from 10 patients with spinal cord injury (C6), brachial plexus trauma, or brachial plexus birth injury. After surgery, the elbow was immobilized in extension for 3 weeks, with no restrictions on elbow flexion following cast removal. After surgery, evaluation focused on active elbow extension, with a median follow-up of 6 months. The cadaveric study demonstrated the feasibility of creating a resistant junction between the deltoid muscle and the lateral intermuscular septum. All but one patient showed strength against manual resistance in elbow extension below the horizontal plane, and 10 of 12 limbs were capable of maintaining elbow extension with the shoulder at 90° abduction, a function that was not attainable before surgery. Two patients achieved active elbow extension with the arm overhead. The technique resulted in improved elbow extension with no notable complications or loss of active shoulder abduction. This technique offers a promising approach to restoring elbow extension in patients with upper limb paralysis. By avoiding tendon grafts and reducing postoperative immobilization, it provides a functional and efficient alternative to the traditional method. Therapeutic IV.