Functional reconstruction of elbow flexion with latissimus dorsi muscle rotational transfer: two case reports

Journal of Medical Case Reports

Case Report

Shinji Yoshida¹  Takayuki Ishii¹  Shou Yanagisawa¹  Masahiko Watanabe¹  Ikuo Saito²  Yuka Kobayashi³  Daisuke Nakajima³  Yoshiyasu Uchiyama³ 

[1] Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 259‑1193, Kanagawa, Japan;Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 259‑1193, Kanagawa, Japan;Department of Orthopaedic Surgery, Isehara Kyodo Hospital, 259-1187, Kanagawa, Japan;Department of Orthopaedic Surgery, Tokai University Hachioji Hospital, Ishikawacho, 192-0032, Hachioji, Tokyo, Japan;

关键词: Biceps brachii;    Brachialis;    Case report;    Elbow flexion;    Latissimus dorsi muscle flap;    Pedicled flap;   

DOI  :  10.1186/s13256-023-04178-4

 received in 2022-08-12, accepted in 2023-09-13,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundWe report two cases of biceps brachii and brachialis paralysis due to musculocutaneous nerve injury in which elbow joint flexion was reconstructed using rotational transfer of the latissimus dorsi muscle with sutures to the radial and ulnar tuberosities, thereby enabling flexion by simultaneous activation of the humeroradial and humeroulnar joints. In cases of associated brachialis paralysis, weaker flexion strength can be expected when the forearm is in a pronated position than when it is in a supinated state. To the best of our knowledge, no previous study has reported the rotational position of the forearm during elbow joint flexion reconstruction.Case presentationCase 1 involved a 30-year-old Asian male who presented with a rupture of the musculocutaneous, median, radial, and ulnar nerves. Reconstruction was performed by rotational transfer of the latissimus dorsi muscle. In this case, the supination and pronation flexion forces were equal. Case 2 involved a 50-year-old Asian man who presented with partial loss of the musculocutaneous nerve, biceps brachii, and pectoralis major due to debridement. Reconstruction was performed by rotational transfer of the latissimus dorsi muscle. In this case, supination and pronation flexion strengths were demonstrated to be equal. Our reconstruction method used the rotational transfer of the latissimus dorsi muscle; the distal muscle flap was divided into radial and ulnar sides to allow elbow joint flexion by simultaneously activating the humeroradial and humeroulnar joints. These sides were then fixed to the anchors at the radial and ulnar tuberosities. Finally, they were wrapped around the myotendinous junction of the biceps brachii or brachialis and secured using sutures.ConclusionsAlthough larger studies are required to verify these methods, this case study successfully demonstrates the following: (1) the flexion strength in the supinated position was equal to that in the pronated position; (2) the stability of the humeroradial and humeroulnar joints was unaffected by the forearm's rotational position; and (3) a satisfactory range of motion of the elbow joint was obtained, with no complications.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

Fig. 7

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