Functional donor-site morbidity after free latissimus dorsi muscle transfer in children

The latissimus dorsi muscle (LDM) is frequently used in reconstructive surgery owing to its size, reliable vascularity, and versatility. It plays a key role in shoulder stability, adduction, and internal rotation. Although donor-site morbidity has been well studied in adults, little is known about long-term functional outcomes in pediatric patients. Given the ongoing musculoskeletal development in children, concerns exist regarding functional recovery, compensatory adaptations, and postural changes. We evaluated long-term donor-site morbidity, shoulder function, and musculoskeletal adaptation in pediatric patients following free LDM transfer.

A cross-sectional study was conducted on pediatric patients who underwent free LDM transfer for soft tissue reconstruction between 2018 and 2021 at a tertiary care center. All procedures were performed by a single surgeon. Patients aged ≤17 years (males) or ≤15 years (females) were included. Donor-site morbidity was assessed once post-operatively using the DASH, SPADI, and Pedia-ASES scores. Functional outcomes included range of motion, shoulder stability, daily activities, and spinal asymmetry.

Twenty-one patients (mean age: 7.0±4.0 years) were included. Trauma was the primary indication (n=19). Flaps were muscle-only (n=9), myocutaneous (n=11), or myofascial (n=1). Functional assessments showed minimal donor-site morbidity and acceptable postoperative outcomes. The mean DASH score was 11.4±12.4, indicating low disability. SPADI pain and disability scores were 10.6±14.5 and 7.6±10.9, respectively. Pedia-ASES scores showed largely preserved function.

Free LDM transfer in pediatric patients results in minimal morbidity and acceptable postoperative functional status, likely owing to adaptive muscle compensation. Further studies should explore long-term biomechanical adaptations and function-sparing techniques.