Free Flap Functional Muscle Transfers

Free Gracilis Muscle Transfers Compared with Nonfree Muscle Flaps for Reanimation of Elbow Flexion: A Meta-Analysis

“…Loss of elbow flexion due to brachial plexopathy or trauma is a dramatically limiting upper extremity injury. 1,2 Although the gracilis muscle has many advantageous properties that make it a suitable choice for FFMT, nerve transfers, Oberlin transfers, and various pedicled muscle grafts have also been utilized for elbow flexion reanimation. 2,[7][8][9][11][12][13]15 Previous studies have reported conflicting outcomes of these transfer options with no study of pooled results currently available.…”

“…1,2 Although the gracilis muscle has many advantageous properties that make it a suitable choice for FFMT, nerve transfers, Oberlin transfers, and various pedicled muscle grafts have also been utilized for elbow flexion reanimation. 2,[7][8][9][11][12][13]15 Previous studies have reported conflicting outcomes of these transfer options with no study of pooled results currently available. [7][8][9]11,13,16 The purpose of this study was to offer a comprehensive analysis of functional outcomes and transfer failure rates to evaluate whether gracilis FFMTs offered any definitive advantages over nonfree muscle transfers.…”

“…DASH score analysis exhibited from both groups result with comparable outcomes; this is noteworthy considering that patients undergoing gracilis free flap may present with more dramatic injury further from the time of injury incidence. 2,12 However, it is also possible that the DASH score is an imperfect outcome tool. In recent years, there has been an explosion of literature focusing on patient-reported outcome measures that may offer improved insight.…”

“…1 Determination of treatment course depends on several factors, including duration since injury, presence of passive elbow flexion, and assessment of available donor muscles and nerves. 1,2 Intercostal, long thoracic, spinal accessory, or thoracodorsal nerve transfers have been previously described as primary treatment options [3][4][5][6] ; however, excessive fibrosis and/or degeneration of the biceps brachii due to late presentation of injury may necessitate pedicled or free muscle transfer for elbow flexion reanimation. [7][8][9][10][11][12][13] Free muscle transfer utilizing the gracilis for restoration of elbow strength was first reported by Ikuta et al in 1979, 14 and has since become increasingly utilized to restore upper extremity function.…”

“…[7][8][9][10][11][12][13] Free muscle transfer utilizing the gracilis for restoration of elbow strength was first reported by Ikuta et al in 1979, 14 and has since become increasingly utilized to restore upper extremity function. 2,15 The gracilis muscle holds many advantages over other graft muscle options that make it more suitable for elbow flexion reanimation. Its contractile fibers run parallel to the muscle's course, its artery and vein are of similar size to the thoracoacromial artery and cephalic vein, and removal of the muscle is not expected to cause noticeable functional deficit in the lower extremity.…”