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S. Zaffagnini, G. M. Marcheggiani Muccioli, V. Chatrath, A. Bondi, V. De Pasquale, D. Martini, B. Bacchelli and M. Marcacci, “Histological and Ultrastructural Evaluation of Leeds-Keio Ligament 20 Years after Implant: A Case Report,” Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 16, No. 11, 2008, pp. 1026-1029. doi:10.1007/s00167-008-0608-9

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• TITLE: A New Method of Limb Salvage and Functional Upper Limb Reconstruction

  AUTHORS: Ruka Shimizu, Kazuo Kishi, Hideo Morioka, Hiroo Yabe

  KEYWORDS: Shoulder; Vascularized Rib; Latissmus Dorsi; Elbow Flexion; Limb Salvage

  JOURNAL NAME: Modern Plastic Surgery, Vol.2 No.4, October 30, 2012

  ABSTRACT: Amputation is frequently used to treat malignant tumors invading into the shoulder joint. When the vessels and major nerves of the upper arm are preserved, however, the limb may be salvaged with a combined osseous, myocutaneous flap. We reconstructed large defects, which included the shoulder joint, using a vascularized rib-latissmus dorsi combined flap. Ribs were connected via the ninth or tenth posterior intercostal artery. Several slits were cut in the ribs, and the rib was glass stick fractured to straighten it. The thoracodorsal nerve was preserved and the latissmus dorsi muscle was transferred to the defect previously occupied by the biceps humerus. The ribs were connected to the residual clavicle via a Leeds-Keio artificial ligament. The flaps completely engrafted. The patient was able to flex her elbow relatively early postoperatively. The function of the hand was preserved intact. In conclusion, the combined vascularized rib-latissmus dorsi flap is useful for patients who require functional or bony reconstruction of large defects involving the shoulder joint.