Background: In the upper extremity, the latissimus dorsi muscle can be used as an ipsilateral rotational muscle flap for soft-tissue coverage or functional reconstruction about the arm and elbow. Patients with major soft-tissue loss and functional deficits can be successfully treated via a single-stage functional latissimus dorsi rotational muscle transfer, which affords soft-tissue coverage and functional restoration.

Methods: Our database was queried for all patients who underwent a rotational latissimus dorsi muscle transfer for soft-tissue coverage and functional restoration of elbow flexion. Four patients were identified. A chart review documented the mechanism of injury, associated injuries, soft-tissue defect size, number of surgical procedures, length of follow-up, elbow range of motion, and flexion strength.

Results: Four patients with loss of elbow flexion resulting from traumatic loss of the anterior compartment muscles and overlying soft tissue underwent soft-tissue coverage and elbow flexorplasty with the ipsilateral latissimus dorsi used for a bipolar muscle rotational tissue transfer. All flaps survived, and Medical Research Council grade 4/5 elbow flexion strength was restored. No additional procedures were required for elbow flexion. The video describes the surgical technique and patient outcomes.

Conclusions: This patient series augments the data in other series supporting the safety and efficacy of this single-stage procedure, which affords soft-tissue coverage and functional restoration of elbow flexion in patients with massive traumatic soft-tissue loss about the arm.