Background: Brachial plexus injuries(BPI) are common in both blunt and penetrating trauma and can result in severe functional upper extremity deficits. Surgical reconstruction of these injuries is complex and often follows a stepladder pattern.Shoulder abductor and elbow flexor re-innervation involves both nerve repair and transfer techniques, which usually give reliable results only with early intervention. If the patients present late, however, or if there is no nerve to transfer or repair (as seen in root avusions),the only remaining option is transfer of a free functioning muscle neurotized by extra-plexal motor nerves to restore function. Freegracilis muscle transfer provides consistent elbow functionin such cases, or in situations where previous nerve grafting and/or nerve transfer have produced disappointing results.The objective of this study is to share our experience of thefree functioning gracilismuscle transfer in restoring elbow flexion.
Methodology:This retrospective study was done over a period of 4 years, by reviewing the records of all patients who underwent free functioning gracilis muscle transfer for restoration of elbow flexion in long-standing brachial plexus injuries.Functional outcomes were assessed clinically through MRC grading system and active range of motion (AROM) at the elbow joint was measured with goniometer.Patients were assessed at the 12 monthsof follow-up.
Result: Total number of patients with successful FFMTs were 21. According to MRC grading system 16 out of 21 (76%) patients were able to achieve power of M3 and above. AROM was <45° in 5 patients, 45° – 90° in 10 patients, and >90° in 6 patients. One patient was able to lift 2 kg weight as well.
Conclusion: Gracilis FFMT is a reliable procedure to restore elbow flexion in patients with brachial plexus injury in which there has been a delay in surgical intervention.
Keywords: Brachial Plexus Injury, gracilis, Free functional muscle transfer