Modification of the L'Episcopo procedure for brachial plexus birth palsies

We reviewed 19 children who had undergone a new modification of the L'Episcopo procedure for obstetric brachial plexus palsy. Through an axillary approach the latissimus dorsi tendon was re-routed anteriorly to the humerus and then anastomosed to the teres major tendon routed posteriorly. At an average follow-up of four years two months, the mean increase in shoulder abduction was 26 degrees and the mean increase in external rotation was 29 degrees. No neurovascular injury or postoperative infection occurred. Two patients had complications, and five did not gain from the procedure. The modified operation was relatively easier to perform and provided excellent cosmesis.