Six patients with flail elbow as a consequence of brachial plexus injury or traumatic loss of arm muscles underwent bipolar transposition of latissimus dorsi myocutaneous or muscle flaps to the biceps brachii to restore elbow flexion. The muscle strength achieved was 1.5-2.5 kg and the total range of active excursion is about 95 degrees. The muscle strength is sufficient to carry out most of the activities of daily life but insufficient to achieve active supination or to perform heavy manual work. Elbow flexion of more than 120 degrees is necessary for the affected hand to reach the mouth and should be one of the goals of the operation. Versatile use of the myocutaneous flap facilitates skin closure and improves the contour of the arm.