Transfert bipolaire de grand pectoral pour la réanimation de la flexion du coude dans une série de 29 patients

Abstract

The aim of this study was to evaluate the functional outcomes of bipolar pedicled pectoralis major (PM) transfer to restore elbow flexion. We retrospectively reviewed 29 transfers in 28 patients who ranged from 5 to 65 years of age (mean age of 31.2 years). The loss of elbow flexion was due to brachial plexus palsy for 24 patients, elbow flexors necrosis in four and poliomyelitis in one patient. The whole PM muscle was mobilized and fixed proximally to the coracoid process. Intraoperative positioning and post-operative immobilization of the shoulder and the elbow flexed at 60° and 120° respectively, allowed direct distal fixation of the muscle to the biceps brachii tendon. Intraoperative positioning and post-operative immobilization of the shoulder and the elbow flexed at 60° and 120° respectively, allowed direct distal fixation of the muscle to the biceps brachii tendon. At the last follow-up (mean of 13 months, ranging from 4 to 37 months), 41% of the transfers (n = 12) recovered grade-4 elbow flexion strength and were able to lift 2.2 kg on average (ranging from 0.5 to 5 kg). Fifty-two per cent of the patients (n = 15) recovered grade-3 strength, and 7% (n = 2) had a poor result (i.e. grade-2 elbow flexion). The mean active elbow flexion was 100° (ranging from 30 to 150°) and the patients had 0 to 10° elbow flexion contracture. Flexion of the shoulder and elbow allowed the transfer to reach the elbow fold, and avoided having to resort to use of an interposition graft between the distal PM and the biceps brachii tendon. Our results indicate that bipolar PM transfer is a reliable and effective procedure to restore elbow flexion.