Anatomical study to investigate the feasibility of pedicled nerve, free vessel gastrocnemius muscle transfer for restoration of biceps function.

A challenging problem is the patient with a total brachial plexus injury with nerve root avulsions. In these patients nerve repair is not possible and no local functioning muscles are available for transfer. Current techniques involve either nerve repair using donor nerves from the contralateral limb or free muscle transfer neurotized by intercostal nerves. The problem with both these techniques is that they are dependent on neural regeneration, which is imperfect. To overcome the problem we propose a technique of transferring a distant muscle whilst retaining its neural supply. Gastrocnemius is a strong muscle and one suitable for free tissue transfer. This study assessed the possibility of transferring gastrocnemius on its neural supply by determining the length of nerve available and whether it was possible to dissect the nerve to gastrocnemius from the main body of the sciatic nerve. We found that the latter was possible, and that the length of dissected nerve would allow transfer of the innervated muscle from the calf to the axilla.