Options of bipolar muscle transfers to restore deltoid function: an anatomical study
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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.
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.
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.
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.
KeywordsLatissimus dorsi Pectoralis major Pedicled flap Bipolar transfer Deltoid palsy
The authors would like to thank the staff of the Anatomy laboratory of the Mayo Clinic for ensuring the availability of the specimens for this study.
MLH: protocol development; data collection; data analysis; manuscript writing. JL: protocol development; data collection; data analysis; manuscript editing. ERW: data analysis; manuscript editing. BTE: protocol development; data analysis; manuscript editing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interests. None of them has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. They have not received or will receive any financial aid, in any form, for this study, from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); or other(s).
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