Pedicle island flaps of latissimus dorsi. Applications in surgical repair of ruptures of the rotator cuff

There are considerable problems in repair of major ruptures of the rotator cuff tendons particularly those of the supra and infraspinatus mm. The Gerb er technique only transfers the tendinous insertion of the latissimus dorsi onto the greater tuberosity in massive cuff ruptures. We have extended thi s approach. In 12 shoulders, we studied the feasibility of a latissimus dor si transfer harvested to fit and bearing muscle and tendon detached at its two extremities and transposed as a neurovascular island. The muscular part is transferred to the infra or supraspinous fossae and the tendon to the g reater tuberosity with the aim of reactivating the infra and supraspinatus muscles. The lateral bundle of the latissimus dorsi is always transferable on its neurovascular pedicle into the infraspinous fossa, even into the sup raspinous fossa, or into both if transfer is used as a bilobed flap. This a natomical work allowed a parallel study of the different possibilities of t ransposing the neurovascular pedicle, which might limit the technique, and also to determine the most appropriate surgical approach.