Transfer of one fascicle of ulnar nerve to functioning free gracilis muscle transplantation for elbow flexion

Background: In brachial plexus injury, elbow flexion is the first priority in reconstruction. Neglected cases need functioning free muscle transplantation that requires the donor nerve to supply the transplanted muscle. The purpose of this study was to investigate the effects and results of transferring one fascicle of the ulnar nerve to the transplanted gracilis muscle. Methods: One woman and two men with neglected avulsions of the C5,C6 roots of the brachial plexus underwent free gracilis muscle transfer for elbow flexion. One fascicle of the ulnar nerve was used as the donor nerve. Results: The mean period of follow‐up was 33.3 months. The average reinnervation time of gracilis muscle was 3.7 months. At the final examination, the mean strength of elbow flexion was 4.3 kgf. The grip strength, moving two‐point discrimination and the strength of the wrist volar flexion on the affected side was not worse than before surgery in any patient at the last follow‐up examination. Conclusions: A fascicle of the ulnar nerve can be one of the most effective options for functioning free muscle transplantation for elbow flexion.