Search

Background Treatment of rotator cuff (RC) tears has not included bipolar muscle-tendon transfers to date. The objective of this study was to verify the feasibility of pedicled bipolar teres major (TM) transfer over and under the long head of the triceps brachii (LHT) and compare its versatility with monopolar transfer in a model of supraspinatus (SS) tears in cadavers. Methods In 6 shoulders of cryopreserved cadavers, we re-created complete SS tears, conducting monopolar and bipolar TM transfers over and under LHT. We compared the morphology of the SS and TM, defect coverage, angle between the transferred TM and major SS axis, and axillary nerve overlap with each technique. Results The TM and SS were morphologically similar. Defect coverage was significantly lower with monopolar transfer (12 ± 4 mm) than with bipolar transfer (39 ± 9 mm under the LHT, P =.003, and 38 ± 8 mm over the LHT, P =.004). The bipolar transfer course over the LHT was the nearest to the SS axis (39° ± 11°, P =.005). We found a greater axillary nerve overlap with bipolar transfer under the LHT (27 ± 8 mm) than with bipolar transfer over the LHT (1 ± 2 mm, P =.005) or monopolar transfer (0 mm, P <.001). Conclusion Bipolar TM transfer is possible without neurovascular pedicle interference, obtaining greater RC defect coverage and the closest path to the SS axis when conducted over the LHT compared with monopolar or bipolar transfer under the LHT. Accordingly, it can be considered an alternative option for the treatment of posterosuperior RC defects. [ABSTRACT FROM AUTHOR]

Background Information in recent literature on the teres major muscle (TM) is limited and, at times, contradictory. Exact information on its neurovascular supply is clinically relevant for its use in a free or pedicled muscle transfer in reconstructive shoulder surgery. Therefore, the aim of this study was to analyze the TM topographically, especially its neurovascular supply and its macroscopic appearance. Materials and methods Thirty upper extremities of 15 human cadavers (7 female and 8 male cadavers) were investigated during the students’ dissection course of our anatomic department in the winter term of 2012. Results The lower subscapular nerve (LSN) innervated the TM in 86.6% of shoulders. In 13.3%, the thoracodorsal nerve (TDN) supplied the muscle. The LSN’s branch was 49.8 ± 11.8 mm long. The TDN’s branch was 83.5 ± 9.8 mm long. The entry of the neurovascular pedicle was located almost in the center part of the muscle. The arterial branch was 33.6 ± 7.3 mm long. Discussion In general, the LSN innervates the TM. However, in 10% to 20% of shoulders, the TDN innervates this muscle. The branch of the TDN supplying the TM is longer than the branch of the LSN. In a muscle transfer, the vessels are the predictable limiting factor for translation because they are shorter than the nerve. The artery, nerve, and vein enter the muscle in a close relationship (<2 cm). It is useful to describe the entry point as an area of 2 cm in diameter around the middle of the TM. [ABSTRACT FROM AUTHOR]