Transplantation of vascularized latissimus dorsalis flaps to the deltoid region for children with obstetrical brachial paralysis sequela

Bipolar transplantation of vascularized pedicle flaps from the latissimus dorsalis to the deltoid region was done in 25 children between the ages of 2 and 14 years. All had sequela of obstetrical brachial plexus paralysis with various degrees of internal rotation contracture. Pre-operative limitation of active abduction ranged 0 to 80 degrees (mean=56 degrees). Muscle transplantation was supplemented in all cases by other musculotendinous and osteoarticular procedures. The surgical procedure and postoperative management are described in detail. All children showed improvement of arm function and shoulder range of motion. Post-operatively, active abduction was 20 to 170 degrees (mean=131 degrees). Internal rotation contracture was reduced and active external rotation was ebabled. There were two complications: one necrosis of the pedicle flap and one traction neuritis of the brachial plexus.