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Updated: Jun 22, 2026
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Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer
Published on: March 1, 2015
Microvascular free functioning gracilis transfer with nerve transfer to establish elbow flexion
1Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
Summary
Free functioning gracilis muscle transfer (FFGMT) effectively restores elbow flexion in upper limb injuries. This surgical technique, particularly successful in obstetric brachial palsy, offers significant functional improvement with a multidisciplinary approach.
Area of Science:
- Reconstructive Microsurgery
- Orthopedic Surgery
- Pediatric Orthopedics
Background:
- Loss of elbow flexion is a rare but debilitating upper limb injury.
- Managing elbow flexion loss presents significant challenges.
Purpose of the Study:
- To evaluate the efficacy of free functioning gracilis muscle transfer (FFGMT) for restoring elbow flexion.
- To analyze outcomes across various etiologies of elbow flexion deficit.
Main Methods:
- Retrospective follow-up of 33 patients undergoing FFGMT for elbow flexion.
- Analysis of patient demographics, indications, and functional outcomes using the Medical Research Council (MRC) scale.
- Comparison of nerve coaptation techniques (intercostal nerves vs. ulnar fascicles).
Main Results:
- Overall success rate of 70% (23/33 patients) for FFGMT.
- Significant functional gains observed, with 70% achieving MRC grade M4 or greater.
- FFGMT demonstrated highest success in obstetric brachial palsy (92% achieved M4+).
- Intercostal nerve transfer resulted in greater MRC grade improvement compared to ulnar fascicles (P=0.05).
Conclusions:
- FFGMT is a viable and effective surgical option for restoring elbow flexion.
- A multidisciplinary team approach enhances outcomes for FFGMT.
- Nerve coaptation strategy, specifically using intercostal nerves, can optimize functional recovery.
