{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T11:46:27Z","timestamp":1775994387605,"version":"3.50.1"},"reference-count":79,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pedicled latissimus dorsi flap (PLDF) and gracilis free flap (GFF) 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. The aim of this study is to compare the results of both techniques.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>\n                      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. Outcomes were synthesized through single\u2010arm meta\u2010analyses using random\u2010effects models, with indirect comparisons between PLDF and GFF performed using\n                      <jats:italic>Z<\/jats:italic>\n                      \u2010tests. Study quality was appraised with MINORS and JBI tools, and publication bias was assessed using funnel plots and Egger's test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty\u2010seven studies comprising 814 patients were included: 19 on PLDF (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009122) and 28 on GFF (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009692). PLDF achieved a higher mean elbow flexion angle (119.2\u00b0; 95% CI 112.5\u00b0\u2013125.9\u00b0) compared to GFF (91.4\u00b0; 95% CI 82.9\u00b0\u201399.9\u00b0), a difference that was statistically significant. Likewise, mean muscle strength was greater with PLDF (MRC 3.85; 95% CI 3.61\u20134.09) than with GFF (MRC 2.95; 95% CI 2.72\u20133.18). In terms of functional thresholds, 95% of patients in the PLDF group achieved at least MRC \u2265\u20093 and 87% reached \u2265\u20094, whereas in the GFF group the corresponding rates were 72% and 65%. Heterogeneity across studies was moderate but consistent with the direction of effect.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PLDF was associated with higher pooled flexion angles and strength values than GFF; however, due to the absence of direct comparative studies, these findings should be interpreted as comparative trends rather than evidence of superiority.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/micr.70207","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T11:44:20Z","timestamp":1772970260000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pedicled Latissimus Dorsi Flap and Gracilis Free Flap for Restoration of Elbow Flexion: Systematic Review and Indirect Comparative Meta\u2010Analysis of Functional Outcomes"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7106-3184","authenticated-orcid":false,"given":"Sergio Asensio","family":"Ramos","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Hospital Clinico San Carlos  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8767-1440","authenticated-orcid":false,"given":"Beatriz Iniesta","family":"Lima","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Hospital Clinico San Carlos  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Santiago Sanz","family":"Medrano","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Hospital Clinico San Carlos  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara Isabel","family":"de Toro Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Hospital Clinico San Carlos  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1759-9868","authenticated-orcid":false,"given":"Francisco","family":"Soldado","sequence":"additional","affiliation":[{"name":"Pediatric Hand Surgery and Microsurgery, Barcelona Children's Hospital, HM Nens, HM Hospitales  Barcelona Spain"},{"name":"Department of Hand Surgery Children's Hospital of Soochow University  Suzhou Jiangsu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier Buend\u00eda","family":"P\u00e9rez","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Hospital Clinico San Carlos  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sap.0000106430.56501.b5"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2024.07.012"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.52312\/JDRS.2021.225"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000000907"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.1920150109"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.3171\/foc.2004.16.5.9"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2000-8390"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hcl.2008.04.001"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2018.05.016"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2017.03.021"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2025.04.005"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100040\u20101708587"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hcl.2004.10.005"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.41B1.36"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.main.2012.10.169"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264\u2010021\u201005108\u2010z"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00440569"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2014.06.020"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30426"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/0363\u20105023(93)90363\u20108"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2011.07.012"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rboe.2015.09.007"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264\u2010020\u201004873\u20107"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534\u2010199304001\u201000021"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0363\u20105023(10)80138\u20108"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0266-7681(05)80236-0"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2013.03.041"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/17531934241229201"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/1753193409348182"},{"issue":"2","key":"e_1_2_10_31_1","first-page":"41","article-title":"Reconstruction of Paralyzed Biceps Brachii Muscle by Transposition of Pedicled Latissimus Dorsi Muscle: Report of Two Cases","volume":"40","author":"Haninec P.","year":"1998","journal-title":"Acta Chirurgiae Plasticae"},{"key":"e_1_2_10_32_1","first-page":"201","article-title":"The Pedicle Latissimus Dorsi Transfer for Reconstruction of the Plexus Brachialis and Brachium","volume":"309","author":"Hirayama T.","year":"1994","journal-title":"Clinical Orthopaedics and Related Research"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.71B2.2647756"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2008.01.004"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2006.11.008"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2006.03.006"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2009.05.021"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/WNP.0000000000000289"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2255\u20104971(15)30408\u20100"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13256\u2010023\u201004178\u20104"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2010.09.013"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010200102000\u201000016"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.70020"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2004-823110"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002471"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2017.01.014"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1097\/BTH.0000000000000248"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.70B4.3403600"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2021.102827"},{"issue":"4","key":"e_1_2_10_50_1","first-page":"775","article-title":"Experiences With the Steindler Flexorplasty at the Elbow","volume":"36","author":"Mayer L.","year":"1954","journal-title":"Journal of Bone and Joint Surgery. American Volume"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0363\u20105023(77)80046\u20104"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0363\u20105023(86)80121\u20106"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.1177\/1558944717702467"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.11124\/JBISRIR\u2010D\u201019\u201000099"},{"key":"e_1_2_10_55_1","first-page":"e34","article-title":"Restoration of Elbow Flexion in Patients With Complete Traumatic and Obstetric Brachial Plexus Injury After Functional Free Gracilis Muscle Transfer: Our Experience and Management","volume":"17","author":"Nath R. K.","year":"2017","journal-title":"Eplasty"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-0712(21)00507-2"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30120"},{"key":"e_1_2_10_58_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_10_59_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2003-39511"},{"key":"e_1_2_10_60_1","doi-asserted-by":"publisher","DOI":"10.1177\/1753193417702029"},{"key":"e_1_2_10_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0753-9053(89)80003-1"},{"key":"e_1_2_10_62_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100041\u20101739962"},{"key":"e_1_2_10_63_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.98B2"},{"issue":"5","key":"e_1_2_10_64_1","first-page":"897","article-title":"Complete Muscle Transposition","volume":"37","author":"Schottstaedt E. R.","year":"1955","journal-title":"Journal of Bone and Joint Surgery. American Volume"},{"key":"e_1_2_10_65_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000637\u2010199706000\u201000005"},{"key":"e_1_2_10_66_1","doi-asserted-by":"publisher","DOI":"10.1590\/1413\u2010785220202804233021"},{"key":"e_1_2_10_67_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1445-2197.2003.02748.x"},{"key":"e_1_2_10_68_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsb.2006.07.007"},{"key":"e_1_2_10_69_1","doi-asserted-by":"publisher","DOI":"10.1097\/CORR.0000000000002311"},{"issue":"4","key":"e_1_2_10_70_1","first-page":"526","article-title":"The Latissimus Dorsi Flap for Reconstruction of the Brachium and Shoulder","volume":"70","author":"Stern P.","year":"1988","journal-title":"Journal of Bone and Joint Surgery. American Volume"},{"key":"e_1_2_10_71_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000405"},{"key":"e_1_2_10_72_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000001066"},{"key":"e_1_2_10_73_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1445\u20102197.2003.02654.x"},{"key":"e_1_2_10_74_1","first-page":"61","article-title":"Latissimus Dorsi Transplantation to Restore Elbow Flexion to the Paralysed Limb","volume":"9","author":"Takami H.","year":"1984","journal-title":"Journal of Bone and Joint Surgery. British and European Volume"},{"key":"e_1_2_10_75_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11552\u2010009\u20109223\u20106"},{"key":"e_1_2_10_76_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2008.06.008"},{"key":"e_1_2_10_77_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2008.06.082"},{"key":"e_1_2_10_78_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep22479"},{"key":"e_1_2_10_79_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2018.05.021"},{"issue":"6","key":"e_1_2_10_80_1","first-page":"1265","article-title":"Latissimus Dorsi Transfer to Restore Elbow Flexion. An Appraisal of Eight Cases","volume":"55","author":"Zancolli E.","year":"1973","journal-title":"Journal of Bone and Joint Surgery. American Volume"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70207","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/micr.70207","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70207","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T10:58:39Z","timestamp":1775991519000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.70207"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":79,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1002\/micr.70207"],"URL":"https:\/\/doi.org\/10.1002\/micr.70207","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"value":"0738-1085","type":"print"},{"value":"1098-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"2025-08-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70207"}}