The Journal of Bone and Joint Surgery, Vol 70, Issue 4 526-535, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc
The latissimus dorsi flap for reconstruction of the brachium and shoulder
PJ Stern and JP Carey
University of Cincinnati College of Medicine, Ohio.
The latissimus dorsi was transferred on its neurovascular pedicle to
reconstruct the shoulder or brachium in nineteen patients. Group I
consisted of seven patients in whom transfer of the latissimus dorsi was
used only to obtain active flexion of the elbow. Although there was
complete necrosis of the transferred muscle in one patient, six patients
achieved an average of 111 degrees of active flexion and full extension of
the elbow. There was only a modest gain in active supination because of
pre-existing pronation contractures. The three patients in Group II had
sustained loss of the flexor muscles of the elbow and the overlying soft
tissue as a result of trauma. After the latissimus dorsi musculocutaneous
flexorplasty, an average of 135 degrees of active flexion of the elbow was
restored, but there was an average loss of 12 degrees of extension. The
three patients in Group III had a large, noninfected defect of the soft
tissue over the shoulder or brachium; the bone, shoulder joint, or
neurovascular structures were exposed in each patient. Transfer of the
latissimus dorsi with the overlying skin provided satisfactory coverage of
the defect. The six patients in Group IV had chronic osteomyelitis or
septic arthritis of the glenohumeral joint. Treatment consisted of radical
debridement of the infected soft tissue and bone followed by transfer of
the latissimus dorsi. This provided satisfactory coverage for subsequent
osteosynthesis of the humerus or arthrodesis of the shoulder when one of
these procedures was indicated. At the time of writing, an average of 2.3
years after the latissimus dorsi transfer, none of the patients in this
group (including one who died nine months post-operatively of unrelated
causes) had drainage.
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