Secondary Surgery, Elbow

Steindler Operation, Pectoralis Major Transfer, Latissimus Dorsi Transfer


Introduction

Less frequently a lack of active elbow flexion can happen. An important number of surgical operations have been described to improve secondarily the elbow flexion. The rationale of these operations is to utilize good functioning muscle, changing their original bony insertion and to direct them to substitute the biceps muscle. They can vary depending on availability of good motors: pectoralis major, latissimus dorsi, wrist flexors, triceps etc.

The Steindler Operation

1. The Steindler operation for deficit of elbow flexion consists of detaching the epycondilear muscles wich are wrist flexors with a fragment of bone and trasforming them into elbow flexors
2. The muscles are then reinserted more proximally on the anterior part of the humerus in order to transform them in elbow flexors
3. The fragment of the bone is fixed to the humerus with a screw. vThe elbow is immobilized in a cast in flexed position for 1 month






The functional result of a Steindler operation with an active flexion of the elbow due to the action of the transposed epitroclear muscle; see the scar at the elbow origin


Pectoralis Major Transfer

1. The transfer of pectoralis major to biceps is indicated expecially in male patients due to the visible scar on the anterior chest
2. The pectoralis major is reinserted to the scapula and to the biceps tendon transforming, in this way, in an elbow flexor





The functional result of a pectoralis major transfer to elbow flexor with a good strenght against resistance


Latissimus Dorsi Transfer

1. The latissimus dorsi muscle is isolated and detached from the chest with a skin island on it
2. The upper part of the muscle is reinserted to the choracoid bone while the distal part is inserted on the biceps tendon on the elbow
3. The transfer is now in place and the skin island provides enough tissue to prevent tension on the muscle. The arm is maintained in a cast during five weeks