Outcome of free gracilis muscle transfer for the restorationof elbow flexion in traumatic brachial plexus palsy

Abstract

Objectives: The aim of this study was to evaluate the functionaloutcomes of patients with free gracilis muscle transfer (FGMT) forthe restoration of elbow flexion. Patients and methods: Between January 2012 and January 2019,a total of 16 patients (13 males, 3 females; mean age: 27.3±11.7years; range: 18 to 53 years) who underwent FGMF to achieveelbow flexion after traumatic brachial plexus palsy (TBPP) wereretrospectively analyzed. Data including demographic and clinicalcharacteristics of the patients, etiology, affected side, injury level,accompanying injuries, time between injury and surgery, follow-uptime, complications, whether nerve reconstruction and artery repairwere performed previously, and details of the procedure wererecorded. The outcome measures were elbow range of motion indegrees, muscle strength, and Disabilities of the Arm, Shoulder andHand (DASH) and Short Form-36 (SF-36) scores. Results: The mean follow-up was 30±11.5 (range, 24 to 42) months.Two patients had C5-C8 injuries, two patients had C6-T1 injuries,and all other patients had injuries to the C5-T1 roots. Muscle strengthwas M3/M4 in 11 (68.8%) patients, M2 in two (12.5%) patients, andM0 in one (6.2%) patient. The median active range of motion of theelbow joint in patients with successful results (M3 and above) wasmeasured as 75 (range, 30 to 100) degrees. A statistically significantimprovement was observed in the pre- and postoperative DASHscores and in some SF-36 subscale scores of patients with successfulresults. Conclusion: Free gracilis muscle flap is a reliable option in therestoration of elbow flexion in patients with TBPP. Although there isan improvement in functional results, disability, and quality of life,there may be no change in patients’ mental status and pain.