Department of General Surgery, Plastic and Reconstructive Surgery Unit, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Am J Case Rep. 2021 Oct 23;22:e933374. doi: 10.12659/AJCR.933374.
BACKGROUND Several surgical procedures to restore elbow flexion have been reported in the literature. Multiple factors direct the selection of appropriate procedures for each patient, including hand dominance, neurovascular injury, and comorbidities. Traumatic damage to the anterior compartment of the arm is an indication for latissimus dorsi transfer, which can restore elbow flexion. Bipolar pedicled latissimus dorsi (LD) flap is a design used very rarely to simultaneously reconstruct biceps brachii soft-tissue defects and regain complete flexion function. We report the case of a 30-year-old man who underwent successful elbow flexion reconstruction using latissimus dorsi muscle transfer following a road traffic accident and upper limb trauma. CASE REPORT A 30-year-old man presented with acute compartment syndrome caused by a road traffic accident and impact trauma to the left arm. The surgical evaluation revealed proximal biceps tendons rapture; therefore, immediate repair and therapeutic fasciotomy were done. Subsequently, unsuccessful repair resulted in total necrosis of the biceps muscle, which necessitated debridement of the biceps muscle. Delayed reconstruction with an LD flap was successfully done after stabilization of the patient's condition. The flap was harvested as free-pedicled, then modified into a tube-like shape to resemble the biceps muscle. CONCLUSIONS This report has shown that the surgical procedure of latissimus dorsi muscle transfer can successfully restore elbow function following upper limb trauma; however, preoperative planning and postoperative follow-up are crucial for functional reconstruction of the upper extremity. In addition, carefully selecting reconstructive surgery considering patient factors, degree of injury, and the institution's capacity are essential factors in achieving optimal function restoration with minimal complications.
已有多种手术方法被报道用于恢复肘部弯曲功能。多种因素决定了为每位患者选择合适手术的方案，包括手的优势侧、神经血管损伤和并存疾病。手臂前间隔的创伤是进行背阔肌转移的指征，可以恢复肘部弯曲。双极带蒂背阔肌（LD）皮瓣是一种很少使用的设计，用于同时重建肱二头肌的软组织缺损并恢复完全的弯曲功能。我们报告了一例 30 岁男性病例，他因道路交通伤和上肢创伤导致急性间隔综合征，成功地进行了背阔肌转移来重建肘部弯曲。
一名 30 岁男性因道路交通伤和左上肢撞击伤导致急性间隔综合征。手术评估显示近端肱二头肌肌腱断裂；因此，立即进行了修复和治疗性筋膜切开术。随后，修复失败导致肱二头肌完全坏死，需要对肱二头肌进行清创。在患者病情稳定后，成功地进行了 LD 皮瓣延迟重建。皮瓣作为游离带蒂皮瓣采集，然后修改成管状形状以模仿肱二头肌。
本报告表明，背阔肌转移手术可以成功恢复上肢创伤后的肘部功能；然而，术前规划和术后随访对于上肢的功能重建至关重要。此外，仔细选择重建手术，考虑患者因素、损伤程度和机构能力是实现最佳功能恢复和最小并发症的关键因素。
