Deltoid muscle flap for massive tears of the rotator cuff

Abstract

Freedom of pain and restoration of shoulder function. Massive tears of the rotator cuff in young physically active patients. Glenohumeral osteoarthritis, cuff arthropathy, paralysis or functional disturbances of the deltoid muscle. Preparation of a distally pedicled flap of the anterolateral part of the deltoid muscle over a length of 5 to 6 cm. Anterior acromioplasty and resection of the lateral end of the clavicle. Extensive mobilization of the retracted ends of the remaining rotator cuff, tenotomy and tenodesis of the long head of the biceps. Rotation of the muscle flap in a posterior direction to cover the defect area over the humeral head. Suture covering well the healthy parts of the cuff. After an average of 2 years postoperatively all 36 patients (4 women, 32 men, average age 52.9 years [39 to 65 years]) operated on between October 1991 and November 1996 were examined. A marked reduction in pain (see Table 3) and an improvement of the active shoulder function could be obtained. Preoperatively, the Constant score amounted to 30.5 and postoperatively to 66 points. An early complication in form of a muscle flap necrosis occurred in 2 patients necessitating a revision. In 3 patients the postoperative course was marked by a rupture or insufficiency of the deltoid flap. Persisting symptoms in 1 patient necessitated a total shoulder replacement. The allover incidence of complications was 18.4% (7 patients, see Table 4).