Latissimus dorsi muscle transfer for restoration of elbow flexion after brachial plexus disruption.

Five patients between 10 and 46 years old were reviewed after a latissimus dorsi muscle transfer to restore elbow flexion. Loss of elbow flexion resulted from traumatic brachial plexus paralysis in all five patients. All had some weakness in other muscle groups in the upper extremity. The follow-up period was from 25 to 68 months (average = 39.4 months). A range of motion of 0 degrees/115 degrees, 10 degrees/100 degrees, 0 degrees/110 degrees, 0 degrees/70 degrees was obtained. After the transfer, three patients could supinate the forearm, and supination of 90 degrees, 15 degrees, and 10 degrees was measured. Two patients could lift 4 lb, while two others could lift 1 and 1.5 lb, respectively. Evaluation of activities of daily living by a standardized test revealed disappointing results. The two patients with less than 90 degrees elbow flexion had initial paralysis of the latissimus dorsi muscle at the time of injury. This procedure should not be done unless the latissimus dorsi muscle is normal.