Functioning free gracilis transfer to reconstruct elbow flexion and quality of life in global brachial plexus injured patients

Abstract

In the study, the functional recovery and relative comprehensive quality of life of cases of global brachial plexus treated with free functioning muscle transfers were investigated. Patients who received functioning gracilis muscle transfer between August 1999 and October 2014 to reconstruct elbow flexion, wrist and fingers extension were recruited. The mean age of the patients was 26.36 (range, 16–42) years. The mean period of time from gracilis transfer to the last follow-up was 54.5 months (range, 12–185 months). Muscle power, active range of motion of the elbow flexion, wrist extension, and total active fingers extension were recorded. SDS, SAS and DASH questionnaires were given to estimate patients’ quality of life. 35.71% reported good elbow flexion and 50.00% reported excellent elbow flexion. The average ROM of the elbow flexion was 106.5° (range, 0–142°) and was 17.00° (range, 0–72°) for wrist extension. The average DASH score was 51.14 (range, 17.5–90.8). The prevalence of anxiety and depression were 42.86% and 45.24%. Thrombosis and bowstringing were the most common short and long-term complications. Based on these findings, free gracilis transfer using accessory nerve as donor nerve is a satisfactory treatment to reconstruct the elbow flexion and wrist extension in global-brachial-plexus-injured patients.

Functioning Free Muscle Transfer for Brachial Plexus Injury: A Systematic Review and Pooled Analysis Comparing Functional Outcomes of Intercostal Nerve and Spinal Accessory Nerve Grafts

“…[10][11][12] The most common donor nerves utilized for the innervation of these muscle transplantations are ICNs or the spinal accessory nerve (SAN). [13][14][15] Success of the FFMT is measured using the modified British Medical Research Council (BMRC) grade which stratifies results into a scale from M0 to M5. A BMRC grade of M3 signifies sufficient power to act against gravity and is generally considered the minimal postoperative strength to be considered a successful procedure.…”

Diagnostic Value and Surgical Implications of the 3D DW-SSFP MRI On the Management of Patients with Brachial Plexus Injuries

“…Brachial plexus injury (BPI) is the most severe nerve injury of the upper extremities and is often associated with trauma such as, motorcycle accidents1. The factors on the restricted recovery of upper limb function, especially those of the hand, after BPI are complicated.…”

Rehabilitation, Using Guided Cerebral Plasticity, of a Brachial Plexus Injury Treated with Intercostal and Phrenic Nerve Transfers

“…In the second procedure, it was necessary to do a free gracilis muscle transfer with the intention to improve elbow flexion (14–16). Because the intercostal nerves had been used in the first surgical procedure, we chose to reinnervate the transferred gracilis muscle through the phrenic nerve (17, 18), which can be done without affecting pulmonary function although intercostal nerves previously have been used (19).…”