Pedicled Latissimus Dorsi Flap and Gracilis Free Flap for Restoration of Elbow Flexion: Systematic Review…

Meta-analysisMicrosurgery· Mar 2026

Pedicled Latissimus Dorsi Flap and Gracilis Free Flap for Restoration of Elbow Flexion: Systematic Review and Indirect Comparative Meta-Analysis of Functional Outcomes.

Sergio Asensio Ramos, Beatriz Iniesta Lima, Santiago Sanz Medrano … Javier Buendía Pérez

Microsurgery & FlapsMeta-analysisQ1IF 1.5

Pedicled latissimus dorsi flap gave greater elbow flexion angle than gracilis free flap

Pedicled Latissimus Dorsi Flap and Gracilis Free Flap for Restoration of Elbow Flexion: Systematic Review and Indirect Comparative Meta-Analysis of Functional Outcomes.

Sergio Asensio Ramos … Javier Buendía Pérez

Microsurgery · Mar 2026 · Q1 in Surgery

Background

Pedicled latissimus dorsi flap (pedicled latissimus dorsi flap) and gracilis free flap (gracilis free flap) are techniques for restoration of elbow flexion after brachial plexus injuries with late presentation or poor outcomes following nerve surgery, as well as after traumatic or oncological loss of arm flexor muscles.

Purpose

The aim of this study is to compare the results of both techniques.

Methods

A systematic review was conducted following PRISMA guidelines, including articles providing information on the maximum degrees of elbow flexion or flexion strength according to the MRC scale.

n = 814 patients

Results

Pedicled latissimus dorsi flap gave notably greater elbow flexion than gracilis free flap

119.2degree

PLDF

91.4degree

GFF

More results

Likewise, mean muscle strength was greater with pedicled latissimus dorsi flap (MRC 3.85; 95% CI 3.61-4.09) than with gracilis free flap (MRC 2.95; 95% CI 2.72-3.18).

More results

In terms of functional thresholds, 95% of patients in the pedicled latissimus dorsi flap group achieved at least MRC ≥ 3 and 87% reached ≥ 4, whereas in the gracilis free flap group the corresponding rates were 72% and 65%.

Heterogeneity across studies was moderate but consistent with the direction of effect.

“

Conclusion

Pedicled latissimus dorsi flap was associated with higher pooled flexion angles and strength values than gracilis free flap; however, due to the absence of direct comparative studies, these findings should be interpreted as comparative trends rather than evidence of superiority.

Pedicled Latissimus Dorsi Flap and Gracilis Free Flap for Restoration of Elbow Flexion: Systematic Review and Indirect Comparative Meta-Analysis of Functional Outcomes.

Pedicled Latissimus Dorsi Flap and Gracilis Free Flap for Restoration of Elbow Flexion: Systematic Review and Indirect Comparative Meta-Analysis of Functional Outcomes.

Related papers