Repair of unstable cuffs with a deltoid flap

We have found that upper arthrolysis for major ruptures of the cuff affecting the supraspinatus and infraspinatus muscles yielded only 40% of excellent and good clinical results at three years, with 1/4 of cases of exenteration of the humeral head on radiographs after 10 years, so that, as early as 1984, we had the idea of using a "tailor-made" active muscle flap taken from the anterior fibers of the middle deltoid muscle (Fick's fibers n degrees III) and sutured to the edges of the trophic perforation after exeresis reaching to the healthy tissue. In our opinion, this procedure is logical as we use a synergic transplant of the ruptured muscles of the cuff, preserving its nerves and blood vessels. This forms a living interposition material between the acromion and the greater tuberosity of the humerus, forming a real "three-bellies" muscle resisting the ascent of the humeral head. In fact, it reconstructs a contained cuff, which plays an important role to lower the humeral head. After a minimum of one year and an average of nineteen months for fifty shoulders, all of these have an esthetically satisfactory appearance, forty-seven are painless or painful only episodically; thirty-two have an active elevation exceeding 120 degrees; twenty-one have a symmetrical muscular strength for elevation and fifteen for outward rotation with 90 degrees abduction. Thirty-nine patients (78%) show satisfactory clinical results. Seventeen humeral heads are realigned. Electromyograms performed after six months showed that the flap contracted synchronously with the supra- and infraspinatus.(ABSTRACT TRUNCATED AT 250 WORDS)