Restoration of elbow function is a challenge for orthopaedic surgeons, and many procedures have been described. This study reviewed 17 patients who underwent latissimus dorsi myocutaneous flap transfer for functional reconstruction of elbow flexion or extension. Of the 10 patients who underwent reconstruction for elbow flexion, grade 4 strength of elbow flexion by manual muscle testing was obtained in 8 and grade 3 was obtained in 2. Mean postoperative active elbow flexion was 111 degrees . Of the 7 patients who underwent reconstruction for elbow extension, grade 4 strength of elbow extension was obtained in 3, grade 3 was obtained in 3, and grade 2 was obtained in 1. The 3 patients showing unsatisfactory restoration of flexion or extension strength had associated preoperative weakness of the latissimus dorsi muscle. Preoperative assessment of the latissimus dorsi muscle was most important for obtaining satisfactory results, because preoperative muscle strength influenced the postoperative functional outcome.