Major upper arm amputations are often accompanied by different levels of soft-tissue divisions involving crushing, traction, and avulsion injuries to various structures. In these cases the goal is not only the re-establishment of circulation, but also functional outcome. Some patients require further reconstruction for functional restoration of elbow flexion and additional soft tissue coverage.
Five patients underwent functional latissimus dorsi transfer for restoration of elbow flexion after successful upper arm replantation at our institution. The transfer was unipolar in four patients and bipolar in one. The patients’ ages ranged from seven to 55 years. The time period between replantation and transfer ranged from two weeks to 12 months.
All flaps healed well with minimal donor site morbidity. At mean 43-month follow-up (range: 22–65 months), functional results were good with M4 in three patients and M3 in two patients for elbow flexion.
The pedicled latissimus dorsi muscle flap is a valuable tool to restore elbow flexion and provide coverage of soft tissue defects after major upper arm replantations.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Macroreplantation: an overview.Microsurgery. 1990; 11: 229-233
- Above elbow limb replantation: functional results.J Hand Surg [Am]. 1986; 11: 682-687
- Traumatic amputation of the upper limb: replantation of the arm.J Trauma. 1989; 29: 876-879
- Major limb replantation in children.Microsurgery. 1991; 12: 221-231
- Upper extremity replantation: three-year experience.Microsurgery. 2000; 20: 202-206
- Major upper limb replantation.Hand Clin. 2001; 17: 395-410
- Rehabilitation of the replanted upper extremity.Plast Reconstr Surg. 2002; 109: 978-981
- Preoperative management of the amputated limb.Emerg Med J. 2005; 22: 478-480
- Nerve regeneration and reinnervation after limb amputation and replantation: clinical and physiological findings.Muscle Nerve. 1990; 13: 291-304
- Late results after nerve transplantation on the upper extremities.Handchir Mikrochir Plast Chir. 2004; 36: 13-18
- Long-term follow-up after finger and upper-limb replantation: clinical, angiologic, and lymphographic studies.J Reconstr Microsurg. 1998; 14: 131-136
- Latissimus dorsi myocutaneous flap to restore elbow flexion and axillary burn contracture: a report on two pediatric patients.J Pediatr Orthop. 1982; 2: 565-568
- Restoration of elbow flexion by latissimus dorsi myocutaneous or muscle flap.Arch Orthop Trauma Surg. 1990; 109: 117-120
- Pedicled latissimus dorsi transfer for immediate soft-tissue coverage and elbow flexion.Plast Reconstr Surg. 1997; 99: 1742-1744
- Functional latissimus dorsi island pedicle musculocutaneous flap to restore elbow flexion in replantation or revascularisation of above-elbow amputations.Handchir Mikrochir Plast Chir. 2003; 35: 51-56
- Immediate functional transfer of the latissimus dorsi myocutaneous island flap for reestablishment of elbow flexion in upper arm replantation: two clinical cases.J Trauma. 2004; 57: 1347-1350
- Traction avulsion amputation of the major upper limb: a proposed new classification, guidelines for acute management, and strategies for secondary reconstruction.Plast Reconstr Surg. 2001; 108: 1624-1638
- Present indications and contraindications for replantation as reflected by long-term functional results.Orthop Clin North Am. 1981; 12: 849-870
- Traction avulsion amputation of the upper extremity replanted by microvascular anastomosis.in: Strickland J.W. Steichen J.B. Difficult Problems in Hand Surgery. Mosby, St. Louis1982: 264
- Limb reconstruction versus amputation: Decision making in massive lower extremity trauma.Clin Orthop. 1989; 243: 92-99
- Limb salvage versus traumatic amputation: A decision based on seven-part predictive index.Ann Surg. 1991; 213: 473-480
- Systemic reperfusion injury during arm replantation requiring Intraoperative amputation.Anaesth Intensive Care. 2002; 30: 71-73
- Extended phrenic nerve transfer.Plast Reconstr Surg. 2003; 112: 354-356
- Restoration of elbow flexion after brachial plexus injury: the role of nerve and muscle transfers.Plast Reconstr Surg. 2000; 106: 1348-1357
Published online: April 25, 2007
Accepted: November 12, 2006
Received: September 17, 2006
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.