Martin Serena, McBride Michael, McGarry Kevin, Eames Michael, Lewis Harry
Regional Plastic Surgery Unit, Ulster Hospital, Northern Ireland.
Orthopaedic Unit, Ulster Hospital, Northern Ireland.
Shoulder Elbow. 2021 Jun;13(3):329-333. doi: 10.1177/1758573219866194. Epub 2019 Aug 12.
To review patients treated with a functional latissimus dorsi flap for congenital and acquired elbow flexion deficits.
Retrospective review of functional latissimus dorsi flaps performed in one regional unit. Patient notes were reviewed to determine aetiology, pre-op deficits and function, surgical technique, complications and outcomes.
A total of six functional latissimus dorsi transfers were performed on four patients. Two patients had bilateral latissimus dorsi transfers for congenital defects. The remaining two procedures were for traumatic defects. Post-operatively both children had excellent outcomes with full range of active movement allowing them to perform key activities of daily living.
Epimysium of latissimus dorsi folded to form a pseudo-tendon, tunnelled subcutaneously and either attached to a remnant of biceps tendon or secured to the radius. Congenital patients achieved better outcomes; pre-operatively, there was no active elbow flexion in all four elbows but 90-100 of passive flexion.
One latissimus dorsi dehiscence which required revision surgery. Two donor-site seromas.
Functional latissimus dorsi transfer has been shown to achieve excellent elbow flexion in patients with congenital absence of biceps and brachialis muscles. Outcomes in older patients with traumatic injuries have been less successful in achieving a full range of active flexion.
回顾采用背阔肌功能肌皮瓣治疗先天性和后天性肘关节屈曲功能障碍患者的情况。
对在一个地区性医疗单位实施的背阔肌功能肌皮瓣手术进行回顾性研究。查阅患者病历，以确定病因、术前功能障碍及功能状况、手术技术、并发症和治疗结果。
共对4例患者实施了6次背阔肌功能转移手术。2例患者因先天性缺陷接受双侧背阔肌转移手术。其余2例手术用于治疗创伤性缺陷。术后，两名儿童均取得了良好的治疗效果，肘关节可进行全范围的主动活动，能够完成日常生活中的关键活动。
将背阔肌的肌外膜折叠形成一条假肌腱，经皮下隧道引出，然后附着于肱二头肌肌腱残端或固定于桡骨。先天性患者的治疗效果更好；术前，4例患者的肘关节均无法主动屈曲，但被动屈曲可达90°-100°。
1例背阔肌裂开，需行翻修手术。2例供区出现血清肿。
对于先天性肱二头肌和肱肌缺失的患者，背阔肌功能转移术已被证明可实现极佳的肘关节屈曲效果。对于年龄较大的创伤性损伤患者，在实现全范围主动屈曲方面的治疗效果欠佳。
