Free Functioning Gracilis Muscle Transfer With and Without Simultaneous Intercostal Nerve Transfer to Musculocutaneous Nerve for Restoration of Elbow Flexion After Traumatic Adult Brachial Pan-Plexus Injury

2017 ◽  
Vol 42 (4) ◽  
pp. 293.e1-293.e7 ◽  
Author(s):  
Andrés A. Maldonado ◽  
Michelle F. Kircher ◽  
Robert J. Spinner ◽  
Allen T. Bishop ◽  
Alexander Y. Shin
Keyword(s):  
Nerve Transfer ◽  
Elbow Flexion ◽  
Intercostal Nerve ◽  
Gracilis Muscle ◽  
Musculocutaneous Nerve ◽  
Muscle Transfer

Cadaveric Evaluation of Myelinated Nerve Fiber Count in the Nerve to the Gracilis Muscle in Relation to Use as a Free Functional Muscle Transfer for Elbow Flexion

2020 ◽  
Vol 36 (05) ◽  
pp. 311-315
Author(s):  
Bilal Mahmood ◽  
Danielle C. Marshall ◽  
Scott W. Wolfe ◽  
Steve K. Lee ◽  
Duretti T. Fufa
Keyword(s):  
Average Length ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Gracilis Muscle ◽  
Preparation Technique ◽  
Muscle Transfer ◽  
Myelinated Nerve ◽  
Count Ratio ◽  
Fresh Frozen ◽  
Using Data

Abstract Background Optimizing axon count is essential for successful nerve transfer surgery, and a donor-to-recipient axon count ratio greater than 0.7:1 has been associated with improved outcomes. A gracilis free functioning muscle transfer (FFMT) is an option to restore elbow flexion, but its axon count has not been evaluated. Our aim was to quantify the axon count of the nerve to the gracilis muscle. Methods The nerve to the gracilis was dissected in 10 fresh frozen adult cadaveric hindquarter specimens (four females and six males). The length of the nerve to the gracilis was measured and a biopsy taken. A validated histologic preparation technique was utilized, and axons were counted. The mean length and axon counts were calculated. Results The average axon count in the nerve to the gracilis was 818 (range = 684–1,000, standard deviation [SD] = 116). The average length was 98 mm (range = 81–115 mm, SD = 13 mm). Conclusion Our study found the average axon count in the nerve to the gracilis was 818. Prior literature suggests axon count ratio greater than 0.7:1 is associated with better clinical outcomes. Using data from prior studies, the spinal accessory, three intercostal, and two intercostal nerves are all sufficient for the transfer to the nerve to the gracilis with donor to recipient ratios of 1.7:1, 1.3:1, and 0.9:1, respectively.

scholarly journals GRACILIS MUSCLE TRANSFER TO ELBOW FLEXION IN BRACHIAL PLEXUS INJURIES

2020 ◽  
Vol 28 (4) ◽  
pp. 165-167
Author(s):  
Gustavo Bersani Silva ◽  
Maurício Rodrigues Lima Neto ◽  
Alvaro Baik Cho ◽  
Raquel Bernardelli Iamaguchi ◽  
Marcelo Rosa de Resende ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Brachial Plexus ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Patient Characteristics ◽  
Gracilis Muscle ◽  
Muscle Transfer ◽  
Level Of Evidence ◽  
Late Treatment ◽  
Functional Muscle Transfer

ABSTRACT Objective: Brachial plexus injury can lead to significant functional deficit for the patient. Elbow flexion restoration is a priority in surgical treatment. Free functional muscle transfer is an option for early or late treatment failure. This study evaluated patient characteristics and elbow flexion muscle strength after gracilis functioning muscle transfer. Methods: Medical records of 95 patients operated from 2003 to 2019 were analyzed and the following variables recorded: age, gender, nerve transfer used to motorize the gracilis muscle, time between trauma and surgery, age at surgery and elbow flexion strength after a minimum of 12 months following functioning muscle transfer. Results: 87 patients were included, averaging 30 years of age (17 to 57 years). Fifty-five achieved elbow flexion muscle strength ≥ M3 (55/87, 65%), with a mean follow-up of 37 months. The nerves used for activation of the transferred gracilis were: 45 spinal accessory, 10 intercostal, 8 median n. fascicles, 22 ulnar n. fascicles and 2 phrenic nerves. Conclusion: Functional muscle transfer is a viable surgical procedure for elbow flexion in chronic traumatic brachial plexus injuries in adults. Level of Evidence II, Retrospective study.

scholarly journals Investigation Into the Optimal Number of Intercostal Nerve Transfers for Musculocutaneous Nerve Reinnervation: A Systematic Review

Hand ◽  
2017 ◽  
Vol 13 (6) ◽  
pp. 621-626 ◽  
Author(s):  
Hyuma A. Leland ◽  
Beina Azadgoli ◽  
Daniel J. Gould ◽  
Mitchel Seruya
Keyword(s):  
Systematic Review ◽  
Brachial Plexus ◽  
Donor Site ◽  
Elbow Flexion ◽  
Donor Site Morbidity ◽  
Intercostal Nerve ◽  
Optimal Number ◽  
Musculocutaneous Nerve ◽  
Nerve Transfers ◽  
Meta Analyses

Background: The purpose of this study was to systematically review outcomes following intercostal nerve (ICN) transfer for restoration of elbow flexion, with a focus on identifying the optimal number of nerve transfers. Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify studies describing ICN transfers to the musculocutaneous nerve (MCN) for traumatic brachial plexus injuries in patients 16 years or older. Demographics were recorded, including age, time to operation, and level of brachial plexus injury. Muscle strength was scored based upon the British Medical Research Council scale. Results: Twelve studies met inclusion criteria for a total of 196 patients. Either 2 (n = 113), 3 (n = 69), or 4 (n = 11) ICNs were transferred to the MCN in each patient. The groups were similar with regard to patient demographics. Elbow flexion ≥M3 was achieved in 71.3% (95% confidence interval [CI], 61.1%-79.7%) of patients with 2 ICNs, 67.7% (95% CI, 55.3%-78.0%) of patients with 3 ICNs, and 77.0% (95% CI, 44.9%-93.2%) of patients with 4 ICNs ( P = .79). Elbow flexion ≥M4 was achieved in 51.1% (95% CI, 37.4%-64.6%) of patients with 2 ICNs, 42.1% (95% CI, 29.5%-55.9%) of patients with 3 ICNs, and 48.4% (95% CI, 19.2%-78.8%) of patients with 4 ICNs ( P = .66). Conclusions: Previous reports have described 2.5 times increased morbidity with each additional ICN harvest. Based on the equivalent strength of elbow flexion irrespective of the number of nerves transferred, 2 ICNs are recommended to the MCN to avoid further donor-site morbidity.

Does technical components of microanastomoses influence the functional outcome of free gracilis muscle transfer for elbow flexion in traumatic brachial plexus injury?

2021 ◽  
pp. 102827
Author(s):  
Francisco Vilmar Felix Martins-Filho ◽  
Fernanda do Carmo Iwase ◽  
Gustavo Bersani Silva ◽  
Alvaro Baik Cho ◽  
Teng Hsiang Wei ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Functional Outcome ◽  
Brachial Plexus Injury ◽  
Elbow Flexion ◽  
Gracilis Muscle ◽  
Muscle Transfer

Free gracilis muscle transfer with ulnar nerve neurotization for elbow flexion restoration

2020 ◽  
Author(s):  
Marcelo R. De Rezende ◽  
Bruno A. Veronesi ◽  
Renata G. Paulos ◽  
Alvaro B. Cho ◽  
Samuel Ribak ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Elbow Flexion ◽  
Gracilis Muscle ◽  
Muscle Transfer

Elbow flexion strength and contractile activity after partial ulnar nerve or intercostal nerve transfers for brachial plexus injuries

2020 ◽  
Vol 45 (8) ◽  
pp. 818-826
Author(s):  
Dawn Sinn Yii Chia ◽  
Kazuteru Doi ◽  
Yasunori Hattori ◽  
Sotetsu Sakamoto
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Muscle Power ◽  
Contractile Activity ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Intercostal Nerve ◽  
Nerve Transfers ◽  
Forearm Muscles ◽  
Flexion Strength

We compared the outcomes of 23 partial ulnar nerve and 15 intercostal nerve transfers for elbow flexion reconstruction in patients with C56 or C567 brachial plexus injuries using manual muscle power, dynamometric measurements of elbow flexion strength and electromyography. The range of elbow flexion and muscle strength recovery to Grade 3 or 4 were comparable between the two groups. The patients with C567 injuries had significantly stronger eccentric contraction after the partial ulnar nerve transfer than after the intercostal nerve transfer ( p < 0.05). Electromyography of individual muscles demonstrated that the patients with partial ulnar nerve transfers were unable to voluntarily isolate biceps contraction and recruited forearm flexors and extensors. The patients after partial ulnar nerve transfer had significantly more activity of the forearm muscles during concentric elbow flexion than after intercostal nerve transfers ( p < 0.05). We conclude that partial ulnar nerve transfers were superior to intercostal nerve transfers when assessed quantitatively with the dynamometer to evaluate elbow flexion, although simultaneous recruitment of forearm muscles may have contributed to the increased elbow flexion strength in the patients with the partial ulnar nerve transfer. Level of evidence: III

The Outcome of Biofeedback Muscle Re-Education after Brachial Plexus Reconstruction: a Case Series

2020 ◽  
Vol 2 (1) ◽  
pp. 35
Author(s):  
Lydia Arfianti ◽  
Ratna Darjanti Haryadi
Keyword(s):  
Brachial Plexus ◽  
Median Time ◽  
Data Extraction ◽  
Case Series ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Rehabilitation Program ◽  
Surgical Reconstruction ◽  
Muscle Transfer ◽  
Functional Muscle Transfer

The purpose of this report was to evaluate the outcome of biofeedback muscle re-education after brachial plexus reconstruction. A case series was conducted based on registry data of Rehabilitation Outpatient Clinic. A total of 20 subjects underwent surgical reconstruction to restore elbow flexion in the period of 2012-2014 were included in the study. All 20 subjects received biofeedback muscle re-education until end June 2015 (data extraction). Oucome measures were time to recovery (months) after surgical reconstruction and patients’ compliance. Recovery is considered when muscle contraction of biceps (nerve transfer) and gracilis (free functional muscle transfer/ FFMT) are ≥ 100μV, recorded using EMG-surface electrode. Of 4 subjects underwent nerve transfer, all showed recovery with median time of 9 months. Of 16 subjects underwent FFMT, 5 showed recovery with median time of 9 months. The majority of subjects in both groups could comply with once in 2 weeks rehabilitation program.

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