Functioning free muscle transfer for the restoration of elbow flexion in brachial plexus injury patients |
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| Affiliation: | 1. Microsurgery Unit, Department of Orthopedics, University of the Philippines, Philippine General Hospital, Manila, Philippines;2. ASTRO (Advanced STudy and Research in Orthopedics), Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines, Manila, Philippines;1. Conservative Surgery Orthopaedic and Innovative Techniques Unit, Department of Complex Orthopaedic-Trauma Pathology, Rizzoli Orthopaedic Institute, Bologna, Italy;2. Service of Immunohematology and Transfusional medicine, Rizzoli Orthopaedic Institute, Bologna, Italy;3. Orthopaedic Pathophysiology and Regenerative Medicine Unit, Department of Complex Orthopaedic-Trauma Pathology Rizzoli Orthopaedic Institute, Bologna, Italy;1. Department of Orthopaedic Surgery, Fatima Hospital, 99 Ayang-ro, Dong-gu, Dae-gu, Republic of Korea;2. Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital, 555 Samjungja-Dong, Changwon-si, Republic of Korea;1. Department of Orthopaedics and Traumatology, Third Faculty of Medicine, Charles University and FNKV, Prague, Czech Republic;2. Center for Integrated Study of Pelvis, Third Faculty of Medicine, Charles University, Prague, Czech Republic;3. Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic;4. Department of Health Care Studies, College of Polytechnics Jihlava, Jihlava, Czech Republic;5. Department of Anatomy, Third Faculty of Medicine, Charles University, Prague, Czech Republic;1. Parvathy Hospital, Chennai, India;2. Sri Ramachandra Medical College, Chennai, India;3. Swaram Hospital, Chennai, India;4. Metha Hospital, Chennai, India;5. MOSC Medical College, Cochin, India |
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| Abstract: | BackgroundRestoration 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 methodsA 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.ResultsThere 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.ConclusionFunctioning 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. |
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| Keywords: | Brachial plexus Free muscle transfer Functional outcome |
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