Latissimus dorsi flap for functional reconstruction of the deltoid: A descriptive and illustrated surgical technique guide

Loss of deltoid function due to irreversible damage to the muscle or its innervation results in severe disability and affects the remainder of the upper extremity even if the elbow, wrist, and fingers remain functional. The pedicled latissimus dorsi flap is our preferred method for restoring shoulder motion in well-selected patients with loss of deltoid function and an at least partially functional rotator cuff. The flap's inherent biomechanical advantages enable superior shoulder flexion and abduction compared with other local muscle transfer techniques described for this condition. Moreover, minimal donor-site morbidity is associated with this procedure, and the flap's ample size is capable of restoring normal shoulder contour in cases of large soft tissue defects. Herein is a descriptive and illustrated surgical technique for performing a functional reconstruction of the deltoid using a pedicled latissimus dorsi flap. Also included is a review of the pertinent anatomy, indications/contraindications, and the outcomes and complications of this procedure.