For the Medical Practitioners
doi: 10.25005/2074-0581-2022-24-2-265-274
THE LATISSIMUS DORSI MUSCLE FLAP TRANSFER IN SURGICAL CORRECTION OF POST-TRAUMATIC UPPER LIMB DYSFUNCTION

M.KH. Malikov1, A.A. Davlatov1,2, D.D. Dzhononov2, N.A. Makhmadkulova3, G.D. Karim-Zade1, B.A. Odinaev1

1Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
2Department of Reconstructive and Plastic Microsurgery, Republican Scientific Center for Cardiovascular Surgery, Dushanbe, Republic of Tajikistan
3Department of Topographic Anatomy and Operative Surgery, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

Objective: To improve the outcomes of surgical correction of upper limb dysfunction (ULD) using the latissimus dorsi flap (LDF).

Methods: ULD occurred in 76 patients with Volkmann's ischemic contracture (VIC), post-traumatic soft tissue defects, and brachial plexitis in 57, 11, and 8 cases, respectively. Out of 57 patients with VIC, in 30 cases, a skin defect was observed along with severe degenerative changes in soft tissues, neurovascular bundles (NVBs) and tendons. Post-traumatic forearm defects (n=11) in 5 cases were accompanied by damage to the NVBs and tendons. In brachial plexitis, isolated injury to the musculocutaneous nerve occurred in 6 patients, and a combination of nerve lesions with radial nerve palsy – in 2 patients.

Results: Transposition of LDF to the biceps brachii for the treatment of brachial plexitis, free muscle transplantation for the treatment of VIC and forearm soft tissue defects were performed in 8, 57, and 11 cases, respectively. Active forearm flexion after the muscle flap transposition was noted after 4 weeks. In contrast, after graft transplantation in VIC, the grip function restoration began after 6 months and improved within 1 year and beyond.

Conclusion: Using the LDF in surgical correction of post-traumatic ULD allowed restoring the lost functions of the crushing grip and forearm flexion. For the forearm, only free flap transplantation with a relatively long period of limb function recovery is possible. In contrast, the traspositioned LDF to the biceps allows achieving the desired functional outcomes in the shortest possible time.

Keywords: Upper limb, latissimus dorsi flap, Volkmann's contracture, soft-tissue defect, brachial plexitis.

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Authors' information:

Malikov Mirzobadal Khalifaevich
Doctor of Medical Sciences, Associate Professor, Head of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-7816-5521
E-mail: mmirzobadal@mail.ru

Davlatov Abdumalik Abdulkhakovich
Candidate of Medical Sciences, Hospital Resident of the Department of Reconstructive and Plastic Microsurgery, Republican Scientific Center for Cardiovascular Surgery; Assistant of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
Researcher ID: AAF-6440-2022
Scopus ID: 21933830600
ORCID ID: 0000-0003-2776-074X
SPIN: 3766-9641
Author ID: 998715
E-mail: davlatov.abdumalik@mail.ru

Dzhononov Dzhonibek Davlatalievich
Candidate of Medical Sciences, Head of the Department of Reconstructive and Plastic Microsurgery, Republican Scientific Center for Cardiovascular Surgery
ORCID ID: 0000-0003-2383-7770
E-mail: dr.jonibek@mail.ru

Makhmadkulova Nigora Akhtamovna
Candidate of Medical Sciences, Assistant of the Department of Topographic Anatomy and Operative Surgery, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-4269-6611
E-mail: malikovanigora@mail.ru

Karim-Zade Gulandom Dzhangovarovna
Candidate of Medical Sciences, Assistant of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
ORCID ID: 0000-0003-0845-3197
E-mail: gulandom71@mail.ru

Odinaev Bakhodur Avezovich
PhD Student of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
ORCID ID: 000-0002-9613-2467
E-mail: medicodinaev@mail.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Malikov Mirzobadal Khalifaevich
Doctor of Medical Sciences, Associate Professor, Head of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University

734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139

Tel.: +992 (907) 305060

E-mail: mmirzobadal@mail.ru

Materials on the topic:
  1. CHALLENGES IN THE DIAGNOSTICS AND TREATMENT OF DUODENUM INJURIES IN CHILDREN
  2. DELAYED RECONSTRUCTIVE SURGERY FOR SEVERE HAND INJURIES
  3. SURGICAL MANAGEMENT OF POST-BURN SCAR EXTENSION CONTRACTURES OF THE TOES
  4. GIANT FRONTOETHMOIDAL OSTEOMAS: A RATIONAL APPROACH TO THE SURGICAL REMOVAL AND THE IMMEDIATE RECONSTRUCTION OF THE ANTERIOR WALL OF THE FRONTAL SINUS
  5. NERVE TRANSFER IN IRREVERSIBLE INJURIES OF UPPER LIMB NERVE: CURRENT KNOWLEDGE AND FUTURE PERSPECTIVE
  6. SURGICAL REPAIR OF LATERAL AND ANTEROLATERAL HERNIAS OF THE ABDOMINAL WALL
  7. RESULTS OF LAPAROSCOPIC AND CONVENTIONAL HERNIOPLASTY IN OLDER PATIENTS AND MORPHOLOGICAL CHANGES IN THE TISSUES OF THE INGUINAL CANAL
  8. IMMEDIATE RESULTS OF URETROPLASTY IN DIFFERENT FORMS OF HYPOSPADIAS
  9. ANALYSIS OF THE EFFICIENCY OF APPLICATION OF THE TWO SURGERY METHODS OF TREATMENT OF THE URETHRAL INJURY CONSEQUENCES
  10. THE OUTCOMES OF THE FOREARM FLAP APPLICATIONS IN THE UPPER LIMB SEVERE INJURIES RECONSTRUCTION

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