Options of bipolar muscle transfers to restore deltoid function: an anatomical study.

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.

Operative Techniques For Treatment Of Chronic Massive Rotator Cuff Lesions : Deltoid Flap Transfer Versus Arthroscopic Debridement.

The treatment of chronic massive rotator cuff lesions remains challenging. Extensive reconstruction techniques as deltoid flap transfer as well as low invasive arthroscopic debridement techniques were established and showed good results. In present study 106 patients with massive rotator cuff lesions were treated by deltoid muscle flap transfer (n = 47 group I) and by arthroscopic debridement (n = 59 group II). Postoperative outcome was determined by amount of pain, range of motion, shoulder functionality according to Constant-Murley Shoulder Score and radiological assessment of acromiohumeral distance (AHD). Statistically analysis was done by the T-Test and Mann-Whitney-U-Test. Both groups showed significant improvement of range of motion compared to preoperative situation, but statistical analysis revealed no significant difference between both groups either in flexion or abduction. Overall shoulder functionality increased significantly in group I (30,2 points) and group II (20,6 points) postoperative, however group I improved significantly more in overall functionality compared to group II (p < 0,01). Therefore, present study showed that surgical treatment with arthroscopic debridement or deltoid muscle flap transfer can improve shoulder function in patients with chronic massive rotator cuff lesions. Deltoid muscle flap showed significantly better results in overall shoulder function and seems superior regarding clinical outcome. However, in regard to the good outcome a detailed risk-benefit analysis should be done before a deltoid-flap transfer is performed.

Primary and submovement control of aiming in C6 tetraplegics following posterior deltoid transfer.

BACKGROUND: Upper limb motor control in fast, goal-directed aiming is altered in tetraplegics following posterior-deltoid musculotendinous transfer. Specifically, movements have similar end-point accuracy but longer duration and lower peak velocity than those of age-matched, neurotypical controls. Here, we examine in detail the interplay between primary movement and submovement phases in five C6 tetraplegic and five control participants. METHODS: Aiming movements were performed in two directions (20 cm away or toward), with or without vision. Trials that contained a submovement phase (i.e., discontinuity in velocity, acceleration or jerk) were identified. Discrete kinematic variables were then extracted on the primary and submovements phases. RESULTS: The presence of submovements did not differ between the tetraplegic (68%) and control (57%) groups, and almost all submovements resulted from acceleration and jerk discontinuities. Tetraplegics tended to make a smaller amplitude primary movement, which had lower peak velocity and greater spatial variability at peak velocity. This was followed by a larger amplitude and longer duration secondary submovement. Peak velocity of primary movement was not related to submovement incidence. Together, the primary and submovement phases of both groups were equally effective in reducing end-point error. CONCLUSIONS: C6 tetraplegic participants exhibit some subtle differences in measures of motor behaviour compared to control participants, but importantly feedforward and feedback processes work effectively in combination to achieve accurate goal-directed aiming.

Surgical technique: posterior deltoid-to-triceps transfer in tetraplegic patients.

Several surgical techniques exist for restoring triceps function in tetraplegic patients. The goal is to establish a more synchronized, better controlled arm that allows increased self-sufficiency and further reconstructive surgery on the hand. To obtain the most secure fixation, adjust the tension, and allow early mobilization, the technique we prefer uses the central tendon of the triceps muscle and bony block fixation reinforced by the palmaris longus.

Reconstruction of superficial deltoid ligaments with allograft tendons in medial ankle instability: A technical report.

BACKGROUND: Deltoid ligament insufficiency can cause arthritic changes with various symptoms in the ankle joint. However, reconstruction procedures of the medial collateral and deltoid ligaments have drawn less attention than those of the lateral ankle ligaments. Few techniques for reconstructing deltoid ligaments are available, and those that are can be complex. OBJECTIVE: We introduce a new surgical method for reconstructing superficial deltoid ligaments that is simple and straightforward. CONCLUSION: With this method, the tibionavicular and tibiocalcaneal ligaments can be reconstructed efficiently and easily.

Tracheoesophageal puncture site closure with single perforator-based deltopectoral flap.

BACKGROUND: Tracheoesophageal puncture (TEP) combined with a voice prosthesis is commonly used for voice production in postlaryngectomy patients. In certain cases, however, leakage occurs around the prosthesis. Many techniques have been described to correct this problem. Surgical closure of the puncture site has to be done if the conservative techniques fail. We present the use of the pedicled deltopectoral flap on the basis of a single perforator in the closure of these fistulae. METHODS: The reported technique was used in 6 patients over a period 8 years from 2004 to 2011. RESULTS: The technique was successful in 5 patients. In 1 case there was dehiscence at the leading edge of the flap because of severe local wound infection. CONCLUSION: The novel technique described by us avoids the need for layered closure or dissection of the trachea and esophagus. It is simple and reliable and provides durable results.