Comparison between donor nerves to motorize the free functional gracilis muscle transfer for elbow flexion: Retrospective study of 38 consecutive cases in traumatic adult brachial plexus injuries

• Published in: Microsurgery 2019-07, Vol.39 (5), p.400-404
• Main Authors: Cho, Alvaro B., Bersani Silva, Gustavo, Pisani, Marina J., Alves, Jairo A., Iamaguchi, Raquel B., Wei, Teng H., Rezende, Marcelo R.
• Format: Article
• Language: English
• Subjects: Accessory nerve; Adolescent; Adult; Brachial plexus; Brachial Plexus - injuries; Brachial Plexus - surgery; Brachial Plexus Neuropathies - etiology; Brachial Plexus Neuropathies - surgery; Cohort Studies; Elbow; Elbow (anatomy); Elbow Joint - injuries; Elbow Joint - surgery; Female; Follow-Up Studies; Free Tissue Flaps - innervation; Free Tissue Flaps - transplantation; Gracilis Muscle - innervation; Gracilis Muscle - transplantation; Humans; Injuries; Injury analysis; Male; Microsurgery; Middle Aged; Muscle strength; Nerve Transfer - methods; Nerves; Peripheral Nerve Injuries - diagnosis; Peripheral Nerve Injuries - surgery; Proportional Hazards Models; Range of Motion, Articular - physiology; Recovery of Function - physiology; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Tissue Donors; Treatment Outcome; Young Adult
• ISSN: 0738-1085; 1098-2752
• DOI: 10.1002/micr.30426

Purpose Elbow flexion deficit is a frequent problem in traumatic brachial plexus injuries and reestablishment of this function is the primary treatment goal. When management is delayed, or the initial acute approach fails, free functional transfer of the gracilis muscle for elbow flexion is the treatment of choice. In this report, the authors present the results of a comparison study on different donor nerves (spinal accessory and ulnar) in elbow flexion reconstruction with gracilis flap for traumatic adult brachial plexus injuries. Methods Retrospective analysis of patients with both total or partial traumatic brachial plexus injuries was carried out. Of the 38 patients enrolled, 37 were male (97.4%) with a mean age of 28.3 years. The mean follow‐up period was 25 months. Postoperative function of the gracilis muscle flap was recorded and patients were divided into two groups according to donor nerve: spinal accessory nerve (SAN) (18 cases), and motor fascicles of the ulnar (ULNAR) (20 cases). Results Twenty‐six cases obtained elbow flexion strength M3 or M4 (68.4%): 0 M0 (0.0%), 4 M1 (10.5%), 8 M2 (21.1%), 9 M3 (23.7%) and 17 M4 (44.7%). The mean interval to first recorded M3 muscular strength was 12.4 months. Functional elbow flexion strength (≥ M3) had the following distribution: SAN 83.3% (15/18) and ULNAR 55.0% (11/20) (p = .086). Conclusion No statistical difference for final muscle strength was found between donor nerve groups.