Malo Le Hanneur1,2, Julia Lee3,4, Eric R Wagner3,5, Bassem T Elhassan3. 1. Department of Orthopedics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. malo.lehanneur@gmail.com. 2. Department of Orthopedics and Traumatology-Service of Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP)-Assistance Publique-Hôpitaux de Paris (APHP), 20 rue Leblanc, 75015, Paris, France. malo.lehanneur@gmail.com. 3. Department of Orthopedics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. 4. Sierra Pacific Orthopedics, 1630 E Herndon Ave, Fresno, CA, 93720, USA. 5. Department of Orthopedic Surgery, Emory University, 201 Dowman Dr, Atlanta, GA, 30322, USA.
Abstract
PURPOSE: To outline the technical details and determine the ranges of two pedicled functioning flaps that are the upper pectoralis major (UPM) and latissimus dorsi (LD) to elucidate their respective indications with regards to deltoid impairment. METHODS: The UPM and LD bipolar transfers were performed in 14 paired cadaveric shoulders, one on each side. The UPM was flipped 180° laterally over its pedicle to be placed onto the anterior deltoid. The LD flap was elevated on its pedicle to be rotated and positioned onto the deltoid mid-axis. Their respective spans were defined according to the deltoid muscle origin and insertion. RESULTS: The UPM outreached the lateral edge of the anterior deltoid origin with a mean distance of 7.3 cm (range 4-9.1 cm) off the lateral edge of the clavicle. Distally, the flap consistently overcame the proximal end of the deltoid tuberosity for a mean distance of 2.1 cm (range 0.9-3.2 cm). The LD flap mdi-axis could be consistently placed onto the deltoid mid-axis; spans of the anterior and posterior borders of the LD flap averaged 1 cm (range - 1 to 2.3 cm) and 0.2 cm (range -1.8 to 1.9 cm), respectively. CONCLUSIONS: The UPM flap optimal indications would be cases with deltoid defects limited to its anterior portion, whereas the LD bipolar transfer could be used in more extensive lesions. Additionally, the distal span of both transfers appears to allow their use in the setting of a reverse shoulder arthroplasty with subsequent humeral lengthening. LEVEL OF EVIDENCE: Non-applicable-basic science study, cadaver dissection.
PURPOSE: To outline the technical details and determine the ranges of two pedicled functioning flaps that are the upper pectoralis major (UPM) and latissimus dorsi (LD) to elucidate their respective indications with regards to deltoid impairment. METHODS: The UPM and LD bipolar transfers were performed in 14 paired cadaveric shoulders, one on each side. The UPM was flipped 180° laterally over its pedicle to be placed onto the anterior deltoid. The LD flap was elevated on its pedicle to be rotated and positioned onto the deltoid mid-axis. Their respective spans were defined according to the deltoid muscle origin and insertion. RESULTS: The UPM outreached the lateral edge of the anterior deltoid origin with a mean distance of 7.3 cm (range 4-9.1 cm) off the lateral edge of the clavicle. Distally, the flap consistently overcame the proximal end of the deltoid tuberosity for a mean distance of 2.1 cm (range 0.9-3.2 cm). The LD flap mdi-axis could be consistently placed onto the deltoid mid-axis; spans of the anterior and posterior borders of the LD flap averaged 1 cm (range - 1 to 2.3 cm) and 0.2 cm (range -1.8 to 1.9 cm), respectively. CONCLUSIONS: The UPM flap optimal indications would be cases with deltoid defects limited to its anterior portion, whereas the LD bipolar transfer could be used in more extensive lesions. Additionally, the distal span of both transfers appears to allow their use in the setting of a reverse shoulder arthroplasty with subsequent humeral lengthening. LEVEL OF EVIDENCE: Non-applicable-basic science study, cadaver dissection.