Experience with the pedicled latissimus dorsi flap for finger reconstruction

The pedicled latissimus dorsi flap was used for the reconstruction of finge r function in 12 patients with severely disabled hands. The fascial origin of the muscle was sutured directly to finger flexors in 6 patients, and to extensors in the other 6 patients in the forearm without severing the neuro vascular pedicle. Voluntary contraction of the muscle was obtained in all p atients. Useful tendon gliding was achieved in 6 patients, thereby providin g total active motion of fingers of >100 degrees. In the remaining 6 patien ts, however, several problems such as stiff finger joints prevented appropr iate tendon gliding, resulting in total active motion of <60 degrees. When these problems are overcome, the pedicled latissimus dorsi muscle can yield satisfactory excursion for extrinsic tendons of the fingers. In contrast t o free muscle transplantation, early and predictable recovery of function c an be obtained using this particular technique without any risk of denervat ion of the muscle. (J Hand Surg 2000;25A:668-673. Copyright (C) 2000 by the American Society for Surgery of the Hand).