Aims. The free latissimus dorsi muscle (LDM) flap represents a workhorse procedure in the field of trauma and plastic surgery. However, only a small number of studies have examined this large group of patients with regard to the morbidity of flap harvest. The aim of this prospective study was therefore to objectively investigate the morbidity of a free LDM flap. Methods. A control group (n = 100) without surgery was recruited to assess the differences in strength and range of motion (ROM) in the shoulder joint with regard to handedness of patients. Additionally, in 40 patients with free LDM flap surgery, these parameters were assessed in an identical manner. Results. We measured higher values for all parameters assessing force in the shoulder joint on the dominant side of patients in the control group. Moreover, LDM flap harvest caused a significant reduction in strength in the glenohumeral joint in all functions of the LDM that were assessed, ranging from 9.0% to 13.8%. Equally, we found a significantly reduced ROM in the shoulder at the side of the flap harvest. For both parameters, this effect was diminished, when the flap harvest took place on the dominant side of the patient. Conclusion. LDM flap surgery leads to a significant impairment of the strength and ROM in the shoulder joint. Moreover, the donor morbidity must be differentiated with regard to handedness: harvest on the non-dominant side potentiates the already existing difference in strength and ROM. Conversely, if the harvest takes place on the dominant side of the patient, this difference is diminished. Cite this article: Bone Jt Open 2024;5(12):1114–1119

Aims: Acquired defects of the back primarily are the result of radiation injury, trauma, tumour ablation, or wound dehiscence and infection. The incidence of these defects is growing, since the demand of spinal operations for degenerative spinal diseases and tumour resections is increasing. The reconstructive techniques for posterior trunk defects have improved, because of the use of muscle ßaps. When there are extensive wounds, free ßap reconstruction may be the only option to assure durable coverage. We wanted to evaluate the outcome of these patients. Methods: We review our series of these reconstructions. Results: 16 patients with difþcult wounds of the posterior trunk were treated with various ßaps. The causes of posterior trunk defects were a post operative wound dehiscence or infection (13), tumour (2), meningomyelocele (1). Mean follow-up period was 63 months. The wound location was cervical area (4), upper and midthoracic area (3), lower thoracic and thoracolumbar area (5), lumbosacral area (2), and sacral area (2). The defects were closed by fasciocutaneous ßaps (3), musculocutaneous trapezius ßaps (4), trapezius muscle ßap (1), latissimus dorsi muscle ßap (1), paraspinous muscle ßaps (3), and gluteus muscle ßap (1). In addition, three patients underwent microvascular transfer of the latissimus dorsi muscle. The exposed orthopedic hardware could be left in place in þve out of seven cases. The muscle ßaps did not cause any major functional deþcit in the donor sites. Conclusions: A high rate of success is obtained in the management of posterior trunk defects with muscle ßaps. Adequate debridement of all devitalised tissues and coverage with well vascularized tissue to obliterate any residual dead space and to cover orthopedic hardware are mandatory and prerequisite

Aim: To study the contribution of humeral avulsion of the glenohumeral ligaments (HAGL) to shoulder instability. Methods: In fourteen fresh cadaver shoulders a selective cutting sequence was performed. After each section an abduction-external rotation manoeuvre with axial compression and translation was carried out to provoke dislocation. The resulting instability was graded on a scale of five, ranging from no translation to a locked dislocation. Results: Cutting of only the inferior glenohumeral ligament complex resulted at the most in increased translation, but not in subluxation. For subluxation to occur, at least the middle glenohumeral ligament needed to be cut. The entire humeral capsuloligamentous complex needed to be sectioned before subluxation or dislocation occurred. In half of the cases an additional lesion of the subscapularis or the latissimus dorsi is necessary to allow a locked antero-inferior dislocation. Conclusion: Extensive damage to the humeral side of the capsulo-ligamentous complex and, frequently, associated lesions of the subscapularis or latissimus dorsi muscles are necessary to allow dislocation. This might be the primary reason for the low incidence of HAGL observed in clinical series of shoulder instability

Aims: The most common contracture secondary to brachial plexus birth injury in the shoulder is the internal rotation-adduction one. The purpose of this study was to report the long-term results of the anterior shoulder release combined with transfer of the teres major and latissimus dorsi muscles posteriorly and laterally to allow them to act as external rotators. Methods: The described surgical procedure was performed in ten patients. Nine of them were male and one female, while eight patients had a lesion of the superior trunk and two had involvement of the entire brachial plexus. The patientsñ age ranged from 5 to 9 years old (av. age: 6 years) at the time of the operation, while the average follow-up time was 30 years (range, 25 to 42 years). Results: No improvement of the active abduction was noticed in any of the patients. The average increase of the active external rotation, which had postoperatively been achieved, was 35¡ and was maintained for an average time of 10 years, after which in eight of them gradually began to reduce. At the end of the second postoperative decade the active external rotation of the arm ranged from -10¡ to 5¡. Conclusions: The satisfactory early results of the described surgical procedure are not permanent. The þnal long-term result was the loss of the initial postoperative active external rotation possibly due to the gradually increasing degeneration of the transferred muscles

Congenital infantile fibrosarcomas (CIFS) is a rare tumor of childhood that can be diagnosed from birth to 15 years. It has a ratio of 3.74/100 000 children and is well defined nosological entity with a well-defined pathogenetic patterns: translocation (12, 15) (p13, q25) with fusion of the gene ETV6-NTRK3. The differential diagnosis of upper CIFS in infants must be made with lymphatic malformations, and when associated with the Kasabach-Merritt phenomenon’s (disseminated intravascular coagulopathy), haemangiomas, emangioendotelioma kaposiforme. In 26% of cases is congenital, while in 63% is diagnosed in the first 5 years. Unlike fibrosarcomas of the adult is characterized by a low rate of metastasis and a high survival rate (90% at 5 years). 74% of cases is observed in the limbs (upper> lower, distal> proximal). The treatment of choice should to be, where possible, limb salvage and the recurrences are variable between 17% and 43%. The purpose of this paper is to present a case of CIFS, the clinical features, the oncological treatment, the reconstructive solutions and functional results obtained after reconstruction. Case report. The child (Z.A. female), was diagnosed with a neoplasia of soft tissues of the right forearm before birth. At birth the child underwent a needle biopsy with a diagnosis of CIFS. The patient received four cycles of chemotherapy with reduction tumor mass of more than 50% of volume. At month four she underwent an exeresi with wide margings and sacrifice of the radial nerve. The reconstruction required a free flap of re-innervated latissimus dorsi muscle. After 30 months from the surgical procedure the child is disease free and has recovered extesion of the muscles of the hand and fingers

Introduction: Large chronic tears of the supra and infraspinatus tendons lead to pain and dysfunction of the shoulder. If conservative treatment fails and repair is impossible, transfer of the latissimus dorsi (LD) muscle can be attempted to substitute for lost of supero-posterior cuff function. Method: In 2003 nad 2004, twenty five patients with an average age of 54,8 years (range, 51 to 62 years) who had ongoing pain and impaired function underwent the LD transfer after ultrasonographic examination and diagnostic arthroscopy as a primary surgery. The patients were examined at an average of fourteen months (range, twelve to twenty six months) after the operation. The results were assessed with use of Constant-Murley score pre–and postoperatively. Results: The mean Constant-Murley score increased from 32,50 points preoperatively to 78,75 points postoperatively. The mean score for pain improved of 8,75 points (from 3,75 to 12,50), activities of daily living improved of 10,00 points (from 6,00 to 16,00), range of motion of 15,00 points (from 14,00 to 29,00) and strengh improved of 11,50 points (from 8,75 to 21,25). 20 patients (80%) were very satisfied and 5 patients (20%) were satisfied. The postoperative pain relief was left as the predominant improvement. No patient was disappointed. All patients stated that they would have the operative procedure again under similar circumstances. There was only one complication – subcutaneous haematoma treated with revision and drainage. Conclusions: Our results indicate that LD transfer is a reasonable approach for salvage of a massive tear of the supero-posterior rotator cuff. Despite the difficult operation technique and long rehabilitation phase, this procedure improves the subjective and objective findings