Assessment of initial results of recovered elbow bend by microsurgery to transfer gracilis muscle flap in the treatment of brachial plexus injuries

Tran Thi Thanh Huyen1,2,, Dao Van Giang2, Nguyen Thi Huong Giang2, Hoang Thi Van2, To Tuan Linh2, Trần Xuân Thach2, Nguyen Hong Ha1,2
1 University of Medicine and Pharmacy/Hanoi National University
2 VietDuc university Hospital

Main Article Content

Abstract

Objectives: To evaluate the results of elbow flexion recovery by gracilis functional free muscle flap transfer (FFMT) technique with the source of the intercostal nerve in patients with late brachial plexus injury.
Subjects of study: Study on 08 patients with brachial plexus injury over 12 months who underwent gracilis FFMT surgery to restore elbow flexion with the source of the ipsilateral intercostal nerve at Viet Duc University Hospital from January 2021 to January 2023.
Objects and methods: Descriptive and prospective studies.
Results: The oldest patient is 54 years old, and the youngest is 3 years old. Mean age is: 25.3 ± 3.9 years old. The ratio of male/female patients = 7/1. The average time of surgery (from the time of the accident to the time of surgery) was: 48.8 ± 18.5 months. Patients had good results in elbow flexion recovery (57.1%), the number of patients with poor results only accounted for 14.3%.
Conclusions: Gracilis-free flexor muscle transfer to restore elbow flexion with ipsilateral intercostal nerve source is a useful option in the surgical treatment of late brachial plexus palsy, helping the patient to return home with work and daily life.

Article Details

References

1. Merrell GA, Barrie KA, Katz DL, Wolfe SW. Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature. The Journal of Hand Surgery. 2001;26(2):303-314.
2. Brown JM, Mackinnon SE. Nerve transfers in the forearm and hand. Hand clinics. 2008;24(4):319-340, v.
3. Chuang DC. Neurotization and free muscle transfer for brachial plexus avulsion injury. Hand clinics. 2007;23(1):91-104.
4. Oberlin C, Durand S, Belheyar Z, Shafi M, David E, Asfazadourian H. Nerve transfers in brachial plexus palsies. Chirurgie de la main. 2009;28(1):1-9.
5. Kay S, Pinder R, Wiper J, Hart A, Jones F, Yates A. Microvascular free functioning gracilis transfer with nerve transfer to establish elbow flexion. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2010;63(7):1142-1149.
6. Ikuta Y, Yoshioka K, Tsuge K. Free muscle graft as applied to brachial plexus injury-case report and experimental study. Annals of the Academy of Medicine, Singapore. 1979;8(4):454-458.
7. Chuang DC, Mardini S, Lin SH, Chen HC. Free proximal gracilis muscle and its skin paddle compound flap transplantation for complex facial paralysis. Plastic and reconstructive surgery. 2004;113(1):126-132; discussion 133-125.
8. Coulet B, Boch C, Boretto J, Lazerges C, Chammas M. Free gracilis muscle transfer to restore elbow flexion in brachial plexus injuries. Orthop Traumatol Surg Res. 2011;97(8):785-792.
9. Maldonado AA, Kircher MF, Spinner RJ, Bishop AT, Shin AY. Free Functioning Gracilis Muscle Transfer With and Without Simultaneous Intercostal Nerve Transfer to Musculocutaneous Nerve for Restoration of Elbow Flexion After Traumatic Adult Brachial Pan-Plexus Injury. The Journal of hand surgery. 2017;42(4):293 e291-293 e297.
10. Nicoson MC, Franco MJ, Tung TH. Donor nerve sources in free functional gracilis muscle transfer for elbow flexion in adult brachial plexus injury. Microsurgery. 2017;37(5):377-382.
11. Coulet B, Boretto JG, Lazerges C, Chammas M. A comparison of intercostal and partial ulnar nerve transfers in restoring elbow flexion following upper brachial plexus injury (C5-C6+/-C7). The Journal of Hand Surgery. 2010;35(8):1297-1303.
12. Chuang DC, Yeh MC, Wei FC. Intercostal nerve transfer of the musculocutaneous nerve in avulsed brachial plexus injuries: evaluation of 66 patients. The Journal of Hand Surgery. 1992;17(5):822-828.
13. Chuang DC, Epstein MD, Yeh MC, Wei FC. Functional restoration of elbow flexion in brachial plexus injuries: results in 167 patients (excluding obstetric brachial plexus injury). The Journal of Hand Surgery. 1993;18(2):285-291.
14. Barrie KA, Steinmann SP, Shin AY, Spinner RJ, Bishop AT. Gracilis free muscle transfer for restoration of function after complete brachial plexus avulsion. Neurosurgical focus. 2004;16(5):E8.
15. Chung DC, Carver N, Wei FC. Results of functioning free muscle transplantation for elbow flexion. The Journal of Hand Surgery. 1996;21(6):1071-1077.
16. Manktelow RT, Zuker RM. The principles of functioning muscle transplantation: applications to the upper arm. Annals of plastic surgery. 1989;22(4):275-282.
17. Chuang DC. Functioning free muscle transplantation for brachial plexus injury. Clinical orthopedics and related research. 1995(314):104-111.
18. Nguyễn VP, Lê V. Đoàn, Vũ H. T., Bùi, V. H., & Nguyễn, H. C. Kết quả điều trị nhổ rễ thần kinh C5, C6, ± C7 đám rối cánh tay bằng phẫu thuật chuyển thần kinh. Bản B của Tạp Chí Khoa học và Công nghệ Việt Nam. 2019;61(7).