Background: Functional restoration of elbow flexion represents
a major reconstructive challenge for post-traumatic
adult brachial plexus injuries. Free functional muscle transfer
(FFMT) is the only hope in patients with a lack of local donor
tissues or delayed presentation.
Objective: To study the outcome of free functional gracilis
for restoration of elbow flexion in late brachial plexus palsy.
Methods: A retrospective review of 15 patients who underwent
free functioning muscle transfer for elbow flexion as part
of their brachial plexus injury reconstruction with an average
of 22-month follow-up period. Report of the clinical outcomes
of flap viability and the degree of elbow flexion restoration by
range of motion and British Medical Research Council (MRC)
grade.
Results: The average age was 37 years, and 60% were
caused by Road Traffic Accidents. The flap survival rate reached
86.6% (n=13). The mean follow-up period was 22 months
(range, 12-30 months). By the end of the follow-up period, 69%
of the transfers had recovered MRC grade >M3 elbow flexion
strength. They could lift an average of 2.7kg (range, 0.5-5kg).
Conclusion: The use of FFMT using the gracilis muscle
is a reliable procedure in the restoration of elbow flexion in
patients with brachial plexus injuries beyond 12 months from
the time of injury and in patients with complete root avulsion
injuries. In the hands of an experienced team, good results can
be achieved.