Reconstruction of elbow flexion after sarcoma excision by a unipolar pedicled latissimus dorsi flap.

Abstract

Introduction: The latissimus dorsi flap is widely used in plastic surgery for covering the upper limb but also for reconstruction the function of the elbow or shoulder. We describe a case of a sarcoma of the anterior compartment of the arm, the surgical removal then the covering and reconstruction of the elbow flexion. This case was carried out by a unipolar pedicled flap of the latissimus dorsi.

Material and methods: Three steps were performed (excision, flap preparation and flap fixation). The functional results (muscle strength, MRC scale) and range of motion (ROM) were analyzed. We performed a small literature review to compare the results.

Results: A complete excision (R0) was carried out with a good vitality of the latissimus dorsi flap. A rapid scarring was obtained, allowing an early start of adjuvant radiotherapy. Muscular strength was 33% less compared to preoperative, MRC scale was classified 4. ROM of the elbow was rated at -10/0/130. One year after the operation, the patient is still in remission.

Conclusion: Our functional results are comparable to those found in the literature. The muscle strength in our case appears to be superior, probably linked to a brachio-radialis muscle still functional. No difference in function has been found in the literature between a unipolar or a bipolar transfer of the latissimus dorsi. This case report confirms the reliable and effective nature of the latissimus dorsi flap. The use of this flap for reconstruction after sarcoma surgery has only few reports in the literature.