Case Report: Modified Latissimus Dorsi Muscle Transfer for Radial Palsy, Presentation of a New Technique

OBJECTIVE The latissimus dorsi muscle transfer finger and wrist extension is a well-known procedure for patients needing replantation or in brachial plexus injuries. To increase the length of the transferred muscle to reach to the finger and wrist extensors, the other authors suggest extending the muscle length by incorporating the iliac crest fascia, which not only prolongs the operation time but also minimizes the chances of a healthy and viable muscle-tendon junction. We present a modification of the standard latissimus dorsi transfer whereby the whole muscle (not partial harvest) is transferred and extended by tendon graft to minimize the distal muscle-tendon problems and inefficient muscle excursion commonly encountered with the thus far reported techniques. METHODS In a 12-year period (1996-2008), 5 patients were treated. Guidelines for patient selection were (1) complete high radial nerve palsy with no simpler solution to address the problem, (2) supple joints and gliding tendons, (3) good patient motivation, and (4) free muscle transfer not feasible or risky. RESULTS Five male patients aged 18 to 45 were treated for the absence of wrist and finger extension due to radial nerve damage or extensor group destruction. They were able to use the transferred muscle for extension with minimal training and physiotherapy. CONCLUSION (1) Transferring the whole muscle ensures a complete neural arborization and better excursion. (2) It ensures a safe tendon suture wherein the muscle-tendon unit is far from the distal end of the skin flap (less possibility of necrosis).