Abstract
Purpose: Crush injury of the upper limb often causes bone and soft tissue damage leading to a paralytic hand. We report our experience with reactivating wrist and finger flexion using a neurotised latissimus dorsi transfer in patients with volkmann syndromes of the forearm.
Material and methods: Mean patient age was 25 years and mean follow-up was three years. The surgical procedure consisted in a free latissimus dorsi flap with arterial suture onto the ulnar artery and neurotisation using the largest median nerve branch innervating the finger flexors. The muscle was fixed proximally on the medial epicondyle; the distal fibrous lamina was divided for suture to the deep flexor tendons. Mobilisation started 21 days after surgery.
Results: The four-month electromyogram demonstrated reinnervation of the latissimus dorsi. The patient recovered thumb-index opposition with flexion of the long fingers enabling daily life activities. All patients required occupational reclassification but stated they were satisfied with the operation. Flexion of the fingers and wrist was active and was not obtained by tenodesis.
Discussion and conclusion: Volkmann syndrome leaves serious sequelae after crush injury to the forearm. The usual surgical techniques enable reduction of claw fingers by distention but do not, due to muscle necrosis, enable proper function. The free latissimus dorsi transfer method improves trophicity of the forearm and, by neurotisation, enables active hand flexion. Because the nervous pedicle of the flap is short, recovery is rapid, avoiding degeneration of the transferred muscle.
The abstracts were prepared by Docteur Jean Barthas. Correspondence should be addressed to him at Secrétariat de la Société S.O.F.C.O.T., 56 rue Boissonade, 75014 Paris.
