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J Reconstr Microsurg 2023; 39(05): 361-366
DOI: 10.1055/s-0042-1757750
Original Article

Outcomes of Functioning Free Gracilis Muscle Transplantation to Restore Elbow Flexion in Late Brachial Plexus Birth Injury

Nicole A. Zelenski
1   Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
2   Department of Plastic and Reconstructive Surgery, Division of Reconstructive Microsurgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
,
Anthony L. Karzon
1   Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
,
Tommy Nai-Jen Chang
2   Department of Plastic and Reconstructive Surgery, Division of Reconstructive Microsurgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
,
David Chwei-Chin Chuang 
2   Department of Plastic and Reconstructive Surgery, Division of Reconstructive Microsurgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
,
Johnny Chuieng-Yi Lu
2   Department of Plastic and Reconstructive Surgery, Division of Reconstructive Microsurgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
› Author Affiliations
Funding None.
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Abstract

Background Restoring elbow function is challenging after late presenting brachial plexus birth injury (BPBI). Free functioning muscle transplantation (FFMT) using the gracilis muscle is a reliable procedure to restore elbow flexion in patients with impaired function after spontaneous recovery or failed surgical reconstruction.

Methods A retrospective review was performed on BPBI patients more than 2 years of age who received a FFMT between January 1993 and January 2018, with the aim of improving elbow flexion as the primary or secondary functional goal. Patients with preoperative elbow flexion Medical Research Council (MRC) grades less than 3 with more than or equal to 18 months of follow-up duration were included in the analysis. Patient demographic information and pre/postoperative clinical parameters including elbow flexion MRC scale, passive elbow range of motion, and complications were recorded. Surgical data including donor nerve choice, site of the FFMT tendon attachment, and necessity of concomitant procedures or reoperation were also analyzed.

Results Fifty-six FFMTs were performed for the primary (29 patients) or secondary (26 patients) objective of restoring elbow flexion. The mean age at the time of the procedure was 9.6 years (standard deviation [SD] = 6.29, R = 3-35). Mean follow-up was 7.9 years (SD = 5.2). Elbow flexion improved from a median MRC grade 2 to 4 after a FFMT (p < 0.05). Patients who had a FFMT to restore two functions had 86% lower elbow flexion MRC grades than those who had a FFMT to restore flexion only (p < 0.05). Patients less than 12 years old at the time of surgery had more complications, reoperations, and rates of a flexion contracture more than or equal to 30 degrees than those aged more than 12 years (p < 0.05).

Conclusion FFMT is a reliable option for upper extremity reanimation. Patients aged less than 12 years old at the time of FFMT had significantly more complications, reoperations, and rates of postoperative elbow flexion contracture more than or equal to 30 degrees, but equivalent elbow flexion MRC grades.

Level of Evidence III

Keywords

brachial plexus birth palsy - obstetric brachial plexus palsy - free functioning muscle transplantation - muscle transfer - elbow flexion

Ethical Approval

Ethical approval for this study was obtained from Chang Gung Memorial Hospital Institutional Review Board.


Informed Consent

Written informed consent was obtained from all subjects before the study.


Authors' Contributions

N.A.Z. performed chart review, data analysis, and wrote the first and final draft of the manuscript. A.L.K. assisted in data analysis, writing, and editing of the manuscript. D.C.C.C. devised the original concept and was the senior author responsible for the surgeries performed in this study. D.C.C.C. and T.N.J.C. edited the first draft of the manuscript. J.L. edited and approved the final draft of the manuscript. All authors were involved in the design and data analysis of the study.




Publication History

Received: 12 April 2022

Accepted: 14 August 2022

Article published online:
19 October 2022

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