Functioning free muscle transfer for the restoration of elbow flexion in brachial plexus injury patients

• Published in: Injury 2016-11, Vol.47 (11), p.2525-2533
• Main Authors: Estrella, Emmanuel P., MD, MSc (Clin Epid), Montales, Tristram D., MD
• Format: Article
• Language: English
• Subjects: Adult; Brachial plexus; Brachial Plexus - injuries; Brachial Plexus - physiopathology; Brachial Plexus - surgery; Elbow Joint - physiopathology; Female; Follow-Up Studies; Free muscle transfer; Functional outcome; Gracilis Muscle - transplantation; Humans; Immobilization; Male; Orthopedics; Range of Motion, Articular; Recovery of Function; Retrospective Studies; Treatment Outcome
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2016.08.011

Abstract Background Restoration of elbow function in traumatic brachial plexus injury patients remains the priority in the reconstruction of the involved extremity. In cases of complete nerve root injuries and in delayed cases, the only option for elbow reconstruction is the functional free muscle transfer. The purpose of this paper was to present the clinical outcomes and complications of functioning free muscle transfers using the gracilis muscle for the restoration of elbow flexion in brachial plexus injury patients in a tertiary institution from January 1, 2005 to January 31, 2014. Patient and methods A retrospective review of all patients who had functioning free muscle transfers for elbow flexion was done with a minimum of 12 months follow-up. Outcome measures were elbow flexion in terms of range of motion in degrees, muscle strength of the transferred muscle, VAS (visual analogue scale) for pain, postoperative DASH scores and complications of the procedure. Results There were 39 males and three females. The average age at the time of surgery was 28.6 (SD, 8.5) years. The average delay to surgery was 16 months (range, 3–120 months). The flap success rate for viability was achieved in 38 of 42 patients. The average follow-up for the 38 patients was 30 months (range, 12–103 months, SD 19 months). Success rate of at least M3/5 muscle strength was achieved in 37 of 42 patients with an average range of elbow flexion of 107° (SD, 20.4°). The average post-operative VAS for pain was 3.6 (SD, 3.0). The average post-operative DASH score was 43.09 (SD, 14.9). There were a total of 10 minor complications and five major complications. Conclusion Functioning free muscle transfer using the gracilis muscle was a reliable procedure in the restoration of elbow flexion in patients with incomplete brachial plexus injury treated beyond 6 months from the time of injury and in patients with complete injuries.