Double free gracilis muscle transfer after complete brachial plexus injury: First Canadian experience

Brachial plexus injury in adults is commonly caused by motorcycle accidents. Surgical management consists of nerve repair and nerve grafting for extraforaminal nerve root or trunk injury, and of neurotization or nerve transfer for nerve roots avulsion. In general, the results regarding restoration of shoulder and elbow function are good but reinnervation of the forearm muscles is less than safisfactory in respect to restoration of hand function. Functioning free muscle transfer in combination with selective nerve transfer is a reasonable alternative surgical procedure.

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Bilateral Elbow Flexion Reconstruction with Functioning Free Muscle Transfer for Obstetric Brachial Plexus Palsy

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2002.0777 ◽

2002 ◽

Vol 27 (5) ◽

pp. 484-486 ◽

Cited By ~ 16

Author(s):

A. S. BALIARSING ◽

K. DOI ◽

Y. HATTORI

Keyword(s):

Brachial Plexus ◽

Elbow Flexion ◽

Gracilis Muscle ◽

Brachial Plexus Palsy ◽

Muscle Transfer ◽

Nerve Roots ◽

Obstetric Brachial Plexus Palsy ◽

Shoulder Joints ◽

Muscle Transfers ◽

Obstetric Brachial Plexus

A child suffered a bilateral obstetric brachial plexus palsy involving the C5 and C6 nerve roots. Abduction of the shoulder joints had recovered by 1 year, but elbow flexion did not recover on either side. Free gracilis muscle transfers were performed on both sides, at an interval of 6 months, to achieve elbow flexion. The spinal accessory nerve was used as the donor nerve.

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Which Nerve to Use? Comparison Between Donor Nerves to Motorize the Free Functional Gracilis Muscle Transfer for Elbow Flexion in Traumatic Brachial Plexus Injuries

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2016.07.026 ◽

2016 ◽

Vol 41 (9) ◽

pp. S15-S16 ◽

Cited By ~ 1

Author(s):

Gustavo Bersani Silva ◽

Jairo A. Alves ◽

Marina J. Pisani ◽

Raquel I. da Costa ◽

Marcelo R. Rezende ◽

...

Keyword(s):

Brachial Plexus ◽

Elbow Flexion ◽

Gracilis Muscle ◽

Muscle Transfer

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DOUBLE FREE FUNCTIONING MUSCLE TRANSFERS FOR BRACHIAL PLEXUS INJURIES: A CASE REPORT

(JOINTS) Journal Orthopaedi and Traumatology Surabaya ◽

10.20473/joints.v8i1.2019.19-24 ◽

2019 ◽

Vol 8 (1) ◽

pp. 19

Author(s):

Heri Suroto ◽

Teddy Heri Wardhana ◽

Farindra Ridhalhi

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Injury ◽

Muscle Transfer ◽

Motorcycle Accident ◽

Longus Muscle ◽

Muscle Transfers ◽

Operative Evaluation ◽

One Year ◽

Adductor Longus ◽

Functional Muscle Transfer

Free functional muscle transfer for brachial plexus injury is one of the alternatives to repair the upper extremity function, where usually one type of muscle is used, the gracillis. The method of using two donor muscles to restore the motor function is worth considering for a better improvement of the quality. A 36 years old man with a complete left brachial plexus injury from C5-T1 due to motorcycle accident. A double free functional muscle transfer was performed using the gracillis muscle and the adductor longus muscle with the arterial source from the thoraco-acromial artery with the phrenic and accessory nerves. The gracillis muscle is used to flex the fingers while the adductor is used for flexing the elbow. A one year post-operative evaluation showed the patient was already capable of flexing his elbow with the muscle score of 3 and also the fingers with the muscle score of 1. The double free functional muscle transfer procedure is effective in achieving the moving function of both the elbow and the hand.

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GRACILIS MUSCLE TRANSFER TO ELBOW FLEXION IN BRACHIAL PLEXUS INJURIES

Acta Ortopédica Brasileira ◽

10.1590/1413-785220202804233021 ◽

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.

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