Free gracilis muscle transfer with ulnar nerve neurotization for elbow flexion restoration
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ORIGINAL PAPER
Free gracilis muscle transfer with ulnar nerve neurotization for elbow flexion restoration Marcelo R. De Rezende 1 Rames M. Junior 1
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Bruno A. Veronesi 1
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Renata G. Paulos 1
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Alvaro B. Cho 1
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Samuel Ribak 1
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Received: 25 April 2020 / Accepted: 9 November 2020 # SICOT aisbl 2020
Abstract Purpose In upper and chronic brachial plexus injuries for which neurological surgery is not a good treatment option, one possibility for gaining elbow flexion is free functional muscle transfer. The primary aim of our study was to evaluate the elbow flexion gain achieved by free gracilis muscle transfer with partial ulnar nerve neurotization. Methods This surgery was performed in 21 patients with upper and chronic (> 12 months) brachial plexus injuries. The level of injury, patient age, the time between trauma and surgery, the affected side, and the aetiology of the lesion were recorded. The primary outcome evaluated was elbow flexion muscle strength, which was measured using the British Medical Research Council (BMRC) scale, in patients with a minimum follow-up period of 12 months. The criterion used to classify elbow flexion as good was a grade of M4 or higher. Results An M4 elbow flexion strength gain was observed in 61.9% of the patients. A gain of M2 or higher was observed in 95.2% of the patients. The mean range of active motion was 77° (range 10 minimum–110 maximum). Conclusion In patients with upper and chronic brachial plexus injuries, free gracilis muscle transfer with ulnar nerve neurotization yields a satisfactory gain in elbow flexion strength and is therefore a good treatment option. Keywords Nerve transfer . Brachial plexus . Ulnar nerve . Flap
Introduction The treatment of traumatic injuries to the brachial plexus presents several challenges. The exponential increase in the use of motorcycles as a means of transportation, especially in developing countries [1], has led to a significant increase in this type of injury, with most injuries involving young people, who in many cases present severe functional sequelae of the injured limb. Until the 1960s, few treatment options were available [2]; currently, however, we have a large therapeutic arsenal that provides a better likelihood of upper limb functional recovery. Among countless advances [3, 4], different types of neurotization have been described [5], which involves the * Marcelo R. De Rezende [email protected] 1
Department of Hand Surgery and Microsurgery, Institute of Orthopedics and Traumatology of the Clinics Hospital, School of Medicine, University of São Paulo (IOT-HCFMUSP), Ovídio Pires de Campos, 333, Cerqueira César, São Paulo, SP 05403-010, Brazil
transfer of a nerve preserved in the lesion to another muscle with a more important function, thus expanding the therapeutic possibilities as this strategy was previously restricted to brachial plexus reconstruction. Despite some controversies, the literature reveals a tendency to establish elbow flexion gain as a priority, especially in high brachial plexus injuries,
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