Inverted free functional gracilis muscle transfer for the restoration of elbow flexion

Chin, Kuo-Kai; Vasdeki, Dionysia; Hart, Andrew

doi:10.1016/j.bjps.2012.07.016

Cited by 5 publications

(5 citation statements)

References 3 publications

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“…For high partial injuries, in addition to these nerves, motor fascicles of the median nerve or ulnar nerve can also be transferred. 6 Currently, the free gracilis flap is the most popular choice for elbow flexion reconstruction -a thin muscle with adequate strength and excursion, reliable neurovascular pedicle, easy dissection, resulting in little functional loss of the lower limb. 7 This study aimed to describe the patients' characteristics and the results of free gracilis muscle transfer to elbow flexion in chronic brachial plexus injuries in adults, after evaluating 87 consecutive cases performed at a university hospital.…”

Section: Introductionmentioning

confidence: 99%

“…For high partial injuries, in addition to these nerves, motor fascicles of the median nerve or ulnar nerve can also be transferred. ( 6 Currently, the free gracilis flap is the most popular choice for elbow flexion reconstruction - a thin muscle with adequate strength and excursion, reliable neurovascular pedicle, easy dissection, resulting in little functional loss of the lower limb. ( 7 …”

Section: Introductionmentioning

confidence: 99%

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Gracilis Muscle Transfer to Elbow Flexion in Brachial Plexus Injuries

et al. 2020

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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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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gracilis Muscle Transfer to Elbow Flexion in Brachial Plexus Injuries

et al. 2020

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“…The inverted orientation of the gracilis muscle free flap has been described to restore elbow flexion in patients affected by brachial plexus injuries (Bertelli, 2019; Chin et al, 2013; Wade et al, 2020). As described by the authors, the original orientation simplifies the coaptation of the recipient nerve to reanimate the muscle flap.…”

Section: Discussionmentioning

confidence: 99%

Inverted gracilis muscle free flap with intraoral vascular anastomoses for facial reanimation in vessel depleted neck: A case report

De Cicco,

Bottini,

Lizambri

et al. 2023

Microsurgery

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The reinnervated gracilis muscle free flap represents a workhorse of facial reanimation. This procedure is carried out secondarily to parotid resections, due to advanced tumors that spread to the surrounding structures. Finding recipient vessels might be problematic if other reconstructive procedures are needed to address the defects. This paper describes a procedure to inset a reinnervated gracilis muscle free flap in a vessel depleted patient, through intraoral anastomoses to avoid venous interposition grafts. A 52‐year‐old man developed an advanced adenocarcinoma of the deep parotid lobe and underwent radical surgical excision including the mandibular ramus, condyle, and facial soft tissues (defect size: 8 cm × 4 cm). A secondary double‐flap reconstruction restored the mandibular defect and inset a cross‐face nerve graft. A third intervention finalized the facial reanimation with a 10 cm reinnervated gracilis muscle free flap. The gracilis flap inset was inverted resulting in the proximal flap (pedicle side) lying on the buccal aspect. This allowed vessel joining from the contralateral side via intraoral anastomoses. No complications occurred within and after the intervention. However, the adenocarcinoma relapsed before reinnervation of the gracilis. The patient also had distant brain and lung metastases and received best supportive care. The inverted gracilis muscle free flap may represent an option for attaining facial reanimation in vessel‐depleted patients avoiding long interposition venous grafts.

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“…11,[22][23][24][25][26][27][28] Hattori et al 8 reported on FFMT in three patients with subclavian injury, but who had intact thoracodorsal and thoracoacromial arteries and had not undergone any previous nerve reconstruction. Bertelli 29 and Chin et al 30 presented series of patients with partial brachial plexus injuries in which the gracilis was reversed, so that its motor branch could be innervated by motor branches of the median or ulnar nerve in the distal aspect of the arm, and revascularized by the radial artery and cephalic vein, with good results. Although none of the authors reported the use of the technique in patients with proximal vascular injury, the procedure could be used in those instances, if the radial artery has good blood flow through collateral circulation and the hand function permitted the use of median/ulnar fascicles as donor nerves.…”

Section: Discussionmentioning

confidence: 99%

Use of the Facial Artery for Free Functioning Muscle Transfers: An Alternative Pedicle for Salvage in Brachial Plexus Lesions with Vascular Injuries

Bhatia

Prabhune

Carvalho

2020

Indian J Plast Surg

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Free functional muscle transfer (FFMT) is a salvage procedure recommended in cases of brachial plexus injury with late presentations or failures of primary nerve reconstruction. The workhorse for most authors is the gracilis, and the most common indication is the restoration of elbow flexion. For successful revascularization of the muscle, donor vessels must be in proximity of the site of the muscle fixation and allow direct coaptation to a donor nerve, ideally without the use of nerve grafts. A major problem occurs when patients have sustained concomitant vascular injuries to the subclavian and/or axillary arteries and had previous surgical dissections in the area where the most common vascular pedicles are located. The authors report the use of the rerouted facial vessels as donors in these complex cases. The surgical technique is presented, along with three cases where the procedure was used. The flaps survived in all the patients and grade > 3/5 muscle contraction was observed in the two patients who had adequate follow-up. Conclusion: the use of the facial vessels as donor vessels is an option to revascularize a FFMT in the setting of severe vascular injury to the subclavian and axillary arteries.

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Inverted free functional gracilis muscle transfer for the restoration of elbow flexion

Cited by 5 publications

References 3 publications

Gracilis Muscle Transfer to Elbow Flexion in Brachial Plexus Injuries

Gracilis Muscle Transfer to Elbow Flexion in Brachial Plexus Injuries

Inverted gracilis muscle free flap with intraoral vascular anastomoses for facial reanimation in vessel depleted neck: A case report

Use of the Facial Artery for Free Functioning Muscle Transfers: An Alternative Pedicle for Salvage in Brachial Plexus Lesions with Vascular Injuries

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