The pedicle latissimus dorsi transfer for reconstruction of the plexus brachialis and brachium.

Abstract

To reconstruct the area from the brachial plexus to the upper arm, pedicle latissimus dorsi muscle transfer was performed in 16 patients. Nine patients underwent functional bipolar transfer for reconstruction of elbow flexion. The surgical results were satisfactory in 6 patients, but were unsatisfactory in 3 because of an incorrect preoperative assessment of the strength of the latissimus dorsi muscle and an unsuitable length of transferred muscle in 2 patients, and because of progression of spastic paralysis caused by cervical myelopathy in the third patient. Seven patients with skin loss and an unstable scar underwent aesthetic unipolar transfer in which the exposed nerve, neurovascular bundle, bone, and joint were covered by a musculocutaneous flap with good vascularity. The surgical results were successful in all 7 patients. Infection was present before transfer in 4 of the 16 patients, but it was successfully treated by simultaneous radical debridement of the infected wound and latissimus dorsi transfer.