Free Functional Gracilis Muscle Transplantation for Reconstruction of Active Elbow Flexion in Posttraumatic Brachial Plexus Lesions

Abstract

Functionally useful results can be expected in 60-75% of patients, especially if there is some residual function (M1 or M2) left ("augmentation indication"). Early free functional muscle transplantation shows best results in patients with direct muscle defect, because all vascular and neuronal structures are still available, and no secondary changes such as fibrosis or joint stiffness are present yet. There are inconsistent results for patients with neurologic insufficiency (i.e., total brachial plexus palsy) or mixed neuromuscular insufficiency, such as compartment syndrome. Especially in complete brachial plexus lesion, free functional muscle transfer is often the only treatment option. Provided there is a good patient selection, satisfactory results can be achieved for elbow flexion. Whether a higher number of axons, as provided by the contralateral C7 transfer, will lead to better results is the topic of an ongoing study.

Muscle conserving free gracilis transfer (mini-gracilis free flap)

“…It is preferred as free muscle transfer for coverage of small- to medium-sized defects, functional muscle transfer for facial palsy[6] and brachial palsies. [7] It has been longitudinally or transversely split and used for free tissue transfer. [35] Our technique utilises a small chunk of gracilis based on its minor pedicle, preserving the continuity of the muscle and its major pedicle.…”

The transversely split gracilis twin free flaps

“…[1] and has historically been used for small soft tissue defects, reconstruction of head and neck deformities,[2] autologous breast reconstruction[3] and functional reconstruction of the face[4] and extremities. [56]…”