ELBOW DEFECT COVERAGE WITH A ONE-STAGED, TUNNELED LATISSIMUS-DORSI TRANSPOSITION FLAP

Upper extremity reconstruction is very challenging due to the unavaila bility of expendable local muscles. A review of the literature reveals that the latissimus dorsi muscle has been used for functional restora tion of elbow extension and flexion as well as soft-tissue coverage of upper arm and shoulder defects. In addition, the latissimus dorsi mus cle has been used for forearm reconstruction. Although we have been un able to find any reports of the use of the latissimus dorsi muscle for pure coverage of complex elbow wounds, we have successfully used the latissimus dorsi transposition flap to cover complex elbow defects in a one-staged procedure for patients. In 3 of 4 patients, the latissimu s dorsi transposition flap was the first choice. In the other patient, the latissimus dorsi flap was successfully used as an alternative cho ice for coverage of an open, comminuted elbow fracture after a failed rectus abdominis free tissue transfer. A technique is described for co verage of complex elbow defects by transferring a latissimus dorsi mus cle on its vascular pedicle with or without an overlying skin island. This procedure is safe, one-staged, and results in minimal donor morbi dity. The latissimus dorsi transposition flap provides reliable covera ge of complex elbow defects and should be considered the flap of choic e for coverage of the elbow.