Teres major flap: surgical anatomy, technique of harvesting, methods of fixation, postoperative management

Abstract

Massive rotator cuff ruptures in patients younger than 65 years represent a therapeutic challenge. Loss of function of the infraspinatus leads to loss of active external rotation and anterior elevation, and upward migration of the humeral head. Combined transfer of latissimus dorsi and teres major has been used since many years to treat sequellae of obstetrical plexus palsy with loss of active external rotation (1–3). Gerber et al., in 1988, first described the use of latissimus dorsi muscle transfer to treat massive rotator cuff tear (4). In 1993, Combes and Mansat (5) performed an anatomical study and showed that the teres major had a vascular and nervous autonomy, and that the biometry of the muscle and the length of its pedicle allowed for transfer of its tendon to the humeral head. Later, other anatomical studies have confirmed these results (6-8). Celli et al. (9) published the first clinical series in 1998 with encouraging results. More recently, some authors have studied the combined transfer of the latissimus dorsi and teres major to treat massive rotator cuff tears involving mainly the supraspinatus and infraspinatus tendons (8). The goal of the different transfer was to recover an external rotation of the shoulder and to obtain a depressor effect on the humeral head to compensate the absence of the supraspinatus and infraspinatus muscles.