Flexorplasty of the elbow

Area of Science:

• Orthopedic Surgery
• Reconstructive Surgery
• Musculoskeletal Research

Background:

• Patients with absent or inadequate elbow flexor power often require surgical intervention.
• Previous muscle transfer techniques have varying degrees of success.
• Proximal advancement of forearm muscles was not suitable for this patient cohort.

Purpose of the Study:

• To evaluate the efficacy of different muscle transfer procedures for restoring elbow flexion.
• To compare the outcomes of pectoralis major, latissimus dorsi, and triceps-to-biceps transfers.
• To assess the functional arc of antigravity elbow flexion achieved by each surgical method.

Main Methods:

• Sixteen patients underwent muscle transfer surgery for elbow flexor weakness.
• Procedures included bipolar pectoralis major transfer (5 patients), latissimus dorsi transfer (5 patients), free latissimus dorsi transfer (3 patients), and triceps-to-biceps transfer (3 patients).
• Follow-up assessments measured the antigravity elbow flexion arc after a mean of 31.5 months.

Main Results:

• Mean elbow flexion arcs: pectoralis transfer (91°), latissimus dorsi transfer (87°), free latissimus dorsi transfer (11°), and triceps-to-biceps transfer (125°).
• Pectoralis and latissimus dorsi transfers demonstrated similarly favorable outcomes for elbow flexion.
• Triceps transfer provided excellent elbow flexion but resulted in loss of active elbow extension; free latissimus dorsi transfers yielded poor results.

Conclusions:

• Bipolar pectoralis major and latissimus dorsi transfers are effective for restoring elbow flexion.
• Triceps-to-biceps transfer reliably restores elbow flexion but compromises elbow extension.
• Free latissimus dorsi transfer is not recommended due to poor functional outcomes.