Restoration of elbow flexion in patient with prolonged incomplete brachial plexus injury treated with bipolar latissimus dorsi muscle transfer: A case report

Introduction

The functional deficits resulting from traumatic brachial plexus damage are substantial. In this study, we provide a clinical case with the successful restoration of elbow and shoulder function following a bipolar latissimus dorsi muscle transfer procedure.

Case presentation

A male patient, aged 26, presented at the outpatient clinic with a primary concern of left upper limb weakness that had persisted for a duration of 1.5 years subsequent to an industrial incident. The patient's motor function was assessed as M0 for shoulder abduction and elbow flexion, indicating a range of motion of zero degrees for both movements. Additionally, the Mayo Elbow Score (MES) measurement was recorded as 60. Persistent tingling feelings were observed in the wrist and hand. The neurological assessment revealed a partial impairment of motor function in the radial, median, and ulnar nerves.

Clinical discussion

The electromyographic assessment provided evidence and substantiated the diagnosis of an incomplete left brachial plexopathy. Prompt restoration of elbow flexion was observed on the initial day subsequent to the surgery, accompanied by a minor degree of shoulder abduction. At the six-month mark, the patient demonstrates the ability to execute a 100-degree flexion of the elbow and a 30-degree abduction of the shoulder, exhibiting motor strength at the M4 level.

Conclusion

Following a late brachial plexus injury, the utilization of a bipolar latissimus dorsi muscle flap has demonstrated an exceptional outcome in the context of elbow reconstruction. The preoperative evaluation of donor muscle strength will serve as a reliable indicator for predicting a favorable postoperative result.