Latissimus Dorsi transfer to Bicep

[Deger]

Hi all,
I am just after a bit of information and perhaps some advice.
I had a Brachial Plexus injury almost three years ago severing all 7 nerves below my collarbone, I had surgery to repair the damage and after reading some of the stories on this web site feel very lucky to have the success that I have from the surgery. I have use of my Tricep and am almost able to create a fist due to my forearm muscle also recovering quite well.
I have recently had a letter from my Consultant suggesting I go for the procedure of transfering the Latissimus Dorsi muscle to replace my Bicep which has not regained any use. I would appreciate anyone who has either heard of or prefferably experienced this procedure to reply with any feedback regarding the success, recovery period and as we all know the pain factor.
This would help me a great deal to prepare for and deal with anything that could come from this surgery. I am very keen to go ahead and I will also give feedback after the process.
Many thanks to anyone that can help.
Deger

[cbe411]

Deger,
I have been talking about his surgery also with my doctor. My lat is extremly weak from my accident so at this time, its noty for me, though i still have hope. There was a guy that I was in therapy with though that DID have this. The recovery rate can vary, as with any surgery, about 6-9 weeks. Then back to therapy and what have you. This guy, Roger, had about 75% use of his biceps the last time i saw him, about 6 months after surgery I think. His scar goes from the mid back to almost the elbow, through the arm pit, but whats a scar if your arm is functional, right?! Who is your doctor? I see Dr. Wolff in Louisville, KY, he is GREAT! Good luck and keep us informed!!!
~Courtney

[admin]

I have had a lattissimus muscle transfer due to a tbpi about 4 yrs ago. I had the operation about a year and a half after the accident and I am happy with the results. You can e-mail me anytime and I will answer any questions you have.

[nlrowen]

Hi Blair,

I was sorry to see your posting about your injury. It looks like it may be similar to my son Josh’s injury. Josh's brachial plexus was completely severed in his left axilla (armpit) when he was knifed, in February 2002. Josh had just turned 21 when this occurred. We live in Phoenix, Arizona, and Josh is a student at Arizona State University.

Josh underwent immediate vascular surgery to reconnect the major vein and artery into his arm. Five days later he underwent surgery to reattach the severed nerves. The surgeon was Dr. Salvatore Lettieri, a reconstructive plastic surgeon, who heads the Mayo Medical School's plastic surgery rotation through Maricopa Regional Medical Center, a level one trauma center in Phoenix.

Josh has experienced some recovery to his hand and tricep. None of this has given him any useful function. He has not recovered anything in his bicep (sound familiar?).

In January 2003, eleven months after the initial surgeries, Josh was evaluated by Dr. Bishop and his team at the Brachial Plexus Clinic at the Mayo Clinic, in Rochester, Minn.

Dr. Bishop said that, because of the vascular damage to his arm, Josh is not a candidate for a Latissimus transfer. Instead, Bishop recommended taking the Josh’s left Pectoral Major and its blood supply, and lay it over Josh’s Bicep to attach to Josh's elbow, to give Josh some possible use of his elbow. This surgery is very disfiguring, expensive, and about 40% successful (according to Bishop). (Dr. Lettieri believes that the vascular injury to Josh's arm should not preclude him from having the Latissimus procedure.)

Dr. Bishop said (but did not volunteer) that he had treated four other patients who had had a complete transsections of the brachial plexus. Lettieri thinks that it is unlikely we'll find anyone with more experience with that type of injury.
With this background in mind, I hope you can answer some of my questions.

We are looking to find someone qualified to give us a second opinion. Who is your doctor, and where is he/she located? Did you consider any others? Is your doctor experienced with the procedure? Did you find anyone else who was? If you have medical insurance, has the company agreed to pay for the procedure?

When we asked Lettieri to recommend someone unaffiliated with the Mayo institutions for a second opinion, he suggested either James Nunley at Duke University Medical Center, or Andrew Eglseder at the Shock Trauma Center at the University of Maryland, in Baltimore. He rated both these doctors equally with Dr. Bishop. We are waiting for Josh's neurologist's recommendations before we set up any appointment. You can find some cursory information about them by plugging their names into the Yahoo search engine. They are both orthopedic surgeons. Both Lettieri and Josh's neurologist said we should be dealing with an orthopedic surgeon, not a neurosurgeon for muscle or tendon transfers.

I do not recall discussing pain issues or overall recovery time with Dr. Bishop. (We were both taken aback that the recommended surgery would be so disfiguring, and probably did not ask all the questions we should have.) Bishop did say that Josh would be hospitalized about five days, after which he could return to Arizona, where he would continue with extensive physical therapy.

Pain has been a significant issue for Josh, as have the side effects of the drugs he's on. He has had to compromise between pain and staying alert enough to continue on with school. It has been tough.

When did you start experiencing any return of function, and has enough returned so that you can use your arm or hand? Did you have significant vascular damage with your injury? If so, did that play a role in determining the type of procedure your doctor recommended? Was a vascular surgeon consulted? If you have insurance, has your company agreed to pay for your surgery?

I'm posting this long message rather than emailing it, in the hopes that someone else might have some useful information.

Thank you for any information you can give us.

Nancy Rowen

[gunther]

Robert Leffert, MD at Massachusetts General Hospital, Boston, MA is one of the guru's of TBPI, I would recommend him highly as he treated me in 1983 with a shoulder fusion. During that time, we did consider lat dorsi/pect major tendon transfers etc. I don't know if he still practices but I'm sure you could find out easily. Good luck.
-Gunther

[admin]

For several months I have experienced a nagging pain starting at the bottom(closest to the bend) of my bicep but have worked thru it. Two weeks ago I was straining to pull at something that was stuck. I felt a snap in my arm at the inside of my elbow and I think I blew out my bicep. Ther is a raised area(swollen) in the crease where my arm bends. Could this be a bicep injury and if so what do I do to get it healed and back to where I can do curls and lift with the arm
Mick

[admin]

About a year and a half ago, i had a latissimus transfer for my biceps... and i must say i am very happy with the results. I had to wait 2 months post-op to start therapy, but i noticed the difference almost right away. The process was slow, and i'm still working at it, but i now have elbow flexion and can life with some weight. My surgeon was Sang-Gil Lee at Mass General in Boston. If you have any questions, e-mail me.

Linsy

ls_hoopstar99@hotmail.com

[david wilson]

Nancy
If you are going to Baltimore go see Dr Belzberg at Johns Hopkins. He is a BPI specialist at the number one Hospital in the nation. He is also a specialist with BPI related pain and a fine fellow. Hope you get some answers. Red

[admin]

hey hope someone can help me im considering haveing this operation soon just would like some feedback an insight about it not many ppl here i australia know much about this op but id like to know as much info as i can

thanks mel in oz