Partial monopolar transfer of pectoralis major for elbow active flexion restoration in children with arthrogryposis

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

BACKGROUND: One of the main problems that limited or made the self-ability of patients with arthrogryposis impossible is the lack of active elbow flexion due to hypoplasia (or aplasia) of the forearm flexors and, especially the m. biceps brachii.

AIM: To evaluate the possibility of active forearm flexion restoration in children with arthrogryposis by partial monopolar transposition of the pectoralis major muscle.

MATERIALS AND METHODS: Elbow active flexion restoration by partial monopolar transposition of the pectoralis major muscle to biceps brachii was conducted in 34 children with arthrogryposis (39 upper limbs) from 2011 to 2020. The muscle autograft included a fragment of the fascia of the m. rectus abdominis. Clinical examinations of patients were performed before and after the operation. Statistical data processing was performed using the software packages Statistica 10 and SAS JMP 11.

RESULTS: The follow-up results were estimated from 6 to 99 months (44.53 ± 31.72) postoperative. The mean age of patients was 6.24 ± 4.24 years. The active postoperative elbow motion was 0°–120° (71.94 ± 33.40). The passive postoperative elbow motion did not change and was 90°–130° (104.12 ± 12.40). Muscles strength after the operation was grade 2–5. Elbow extension was limited in 30 cases (76.9%) from 0° to 40° (21.70 ± 12.27) without problem in the activities of daily living. Good results were determined in 15 cases (38.5%), satisfactory in 8 (20.5%), and poor in 16 (41%).

CONCLUSIONS: This study revealed that our partial monopolar transfer of pectoralis major to biceps brachii technic restored sufficient forearm flexion and improved self-ability without forming severe elbow flexor contractures of more than half of the patients with arthrogryposis.

Full Text

Restricted Access

About the authors

Olga E. Agranovich

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: olga_agranovich@yahoo.com
ORCID iD: 0000-0002-6655-4108
SPIN-code: 4393-3694
Scopus Author ID: 56913386600
http://www.rosturner.ru/kl10.htm

MD, PhD, D.Sc., head of the department of arthrogryposis, member of the Paediatric Hand International Society Of Surgeons (PHISOS), Federation of European Societies for Surgery of the Hand (FESSH), The International study group on arthrogryposis

Russian Federation, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Ekaterina V. Petrova

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: pet_kitten@mail.ru
ORCID iD: 0000-0002-1596-3358
SPIN-code: 2492-1260
Scopus Author ID: 57194563255

MD, PhD

Russian Federation, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Sergey F. Batkin

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: sergey-batkin@mail.ru
ORCID iD: 0000-0001-9992-8906
SPIN-code: 5173-9340

MD, orthopedic surgeon

Russian Federation, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Evgeniya I. Ermolovich

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: dr.lazareva@bk.ru
ORCID iD: 0000-0001-6716-1034
SPIN-code: 6598-5653

MD, neurologist

Russian Federation, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Igor A. Komolkin

Saint Petersburg State Research Institute of Phthisiopulmonology

Email: igor_komolkin@mail.ru
ORCID iD: 0000-0002-0021-9008
SPIN-code: 2024-2919

MD, PhD, D.Sc

Russian Federation, Saint Petersburg

Vladimir M. Kenis

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: kenis@mail.ru
ORCID iD: 0000-0002-7651-8485
SPIN-code: 5597-8832
Scopus Author ID: 36191914200
ResearcherId: K-8112-2013

MD, PhD, D.Sc., Professor

Russian Federation, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Andrey V. Sapogovskiy

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: sapogovskiy@gmail.com
ORCID iD: 0000-0002-5762-4477
SPIN-code: 2068-2102
Scopus Author ID: 57193257532

MD, PhD

Russian Federation, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Evgeniy D. Blagoveschenskiy

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery; National Research University “Higher School of Economics”

Author for correspondence.
Email: eblagovechensky@hse.ru
ORCID iD: 0000-0002-0955-6633
SPIN-code: 2811-5723
Scopus Author ID: 6506349269
ResearcherId: B-5037-2014

PhD

Russian Federation, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603; Moscow

References

  1. Hall JG. Arthrogryposis multiplex congenita: etiology, genetics, classification, diagnostic approach, and general aspects. J Pediatr Orthop B. 1997;6(3):159−166.
  2. Sarwark JF, MacEwen GD, Scott CI Jr. Amyoplasia (a common form of arthrogryposis). J Bone Joint Surg Am. 1990;72(3):465−469.
  3. van Heest A, Waters PM, Simmons BP. Surgical treatment of arthrogryposis of the elbow. J Hand Surg Am. 1998;23(6):1063−1070. doi: 10.1016/S0363-5023(98)80017-8
  4. Zargarbashi R, Nabian MH, Werthel JD, Valenti P. Is bipolar latissimus dorsi transfer a reliable option to restore elbow flexion in children with arthrogryposis? A review of 13 tendon transfers. Shoulder Elbow Surg. 2017;26(11):2004−2009. doi: 10.1016/j.jse.2017.04.002
  5. Oishi S, Agranovich O, Zlotolow D, et al. Treatment and outcomes of arthrogryposis in the upper extremity. Am J Med Genet C Semin Med Genet. 2019;181(3):363−371. doi: 10.1002/ajmg.c.31722
  6. Takagi T, Seki A, Kobayashi Y, et al. Isolated muscle transfer to restore elbow flexion in children with arthrogryposis. J Hand Surg Asian Pac Vol. 2016;21(1):44−48. doi: 10.1142/S2424835516500053
  7. Chomiak J, Dungl P. Reconstruction of elbow flexion in arthrogryposis multiplex congenita type I. Part I: surgical anatomy and vascular and nerve supply of the pectoralis major muscle as a basis for muscle transfer. J Child Orthop. 2008;2(5):357−364. doi: 10.1007/s11832-008-0130-0
  8. Sochol KM, Edwards G 3rd, Stevanovic M. Restoration of elbow flexion with a free functional gracilis muscle transfer in an ar-throgrypotic patient using a motor nerve to pectoralis major. Hand (NY). 2020;15(5):739−743. doi: 10.1177/1558944720923412
  9. Chomiak J, Dungl P, Včelák J. Reconstruction of elbow flexion in arthrogryposis multiplex congenita type I: results of transfer of pectoralis major muscle with follow-up at skeletal maturity. J Pediatr Orthop. 2014;34(8):799–807. doi: 10.1097/BPO.0000000000000204
  10. Clark JMP. Reconstruction of biceps brachii by pectoral muscle transplantation. Br J Surg. 1946;34(134):180−181.
  11. Ezaki M. Treatment of the upper limb in the child with arthrogryposis. Hand Clin. 2000;16(4):703−711.
  12. Atkins RM, Bell MJ, Sharrard WJ. Pectoralis major transfer for paralysis of elbow flexion in children. J Bone Joint Surg Br. 1985;67(4):640−644. doi: 10.1302/0301-620X.67B4.4030867
  13. Carroll RE, Kleinman WB. Pectoralis major transplantation to restore elbow flexion to the paralytic limb. J Hand Surg Am. 1979;4(6):501−507. doi: 10.1016/s0363-5023(79)80001-5
  14. Lahoti O, Bell MJ. Transfer of pectoralis major in arthrogryposis to restore elbow flexion: deteriorating results in the long term. J Bone Joint Surg Br. 2005;87(6):858−860. doi: 10.1302/0301-620X.87B6.15506
  15. Doyle JR, James PM, Larsen LJ, Ashley RK. Restoration of elbow flexion in arthrogryposis multiplex congenita. J Hand Surg Am. 1980;5(2):149−152. doi: 10.1016/s0363-5023(80)80146-8
  16. Tsai TM, Kalisman M, Burns J, Kleinert HE. Restoration of elbow flexion by pectoralis major and pectoralis minor transfer. J Hand Surg Am. 1983;8(2):186−190. doi: 10.1016/s0363-5023(83)80013-6
  17. Cambon-Binder A, Walch A, Marcheix PS, Belkheyar Z. Bipolar transfer of the pectoralis major muscle for restoration of elbow flexion in 29 cases. J Shoulder Elbow Surg. 2018;27(11):e330−e336. doi: 10.1016/j.jse.2018.06.027
  18. Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am. 1981;63(6):872−877.
  19. Tobin GR. Segmentally split pectoral girdle muscle flaps for chest-wall and intrathoracic reconstruction. Clin Plast Surg. 1990;17(4):683−696.

Supplementary files

Supplementary Files
Action
1. Fig. 4. Good result of partial unipolar transplantation of the pectoralis major muscle into the flexor position of the right forearm in patient N., 1 year old

Download (236KB)
2. Fig. 6. View of the mammary gland after partial unipolar transplantation of the pectoralis major muscle on the right 6 years after surgery

Download (89KB)
3. Fig. 1. Diagram of the range in “Active flexion, deg.” before and after surgery

Download (22KB)
4. Fig. 2. Diagram of the range in “Forearm flexor muscle strength, points” before and after surgery

Download (27KB)
5. Fig. 3. Diagram of the range in “Extension deficit, deg.” before and after surgery

Download (24KB)
6. Fig. 5. Dynamics of the “Extension deficit” indicator: a, in degrees; b, in percent

Download (57KB)

Copyright (c) 2021 Agranovich O.E., Petrova E.V., Batkin S.F., Ermolovich E.I., Komolkin I.A., Kenis V. ., Sapogovskiy A.V., Blagoveschenskiy E.D.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies