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Updated: Jun 18, 2026
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Structured Motor Rehabilitation After Selective Nerve Transfers
Published on: August 15, 2019
Free muscle transfer in posttraumatic plexopathies: part III. The hand
Julia K Terzis1, Vasileios K Kostopoulos
1Norfolk, Va. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School.
Plastic and Reconstructive Surgery
|November 26, 2009
Summary
Free muscle transfers offer hope for paralyzed hands in severe brachial plexus injuries. The spinal accessory nerve is a strong donor for finger extension, while intercostal nerves aid flexion.
Area of Science:
- Microsurgery
- Reconstructive surgery
- Peripheral nerve surgery
Background:
- Brachial plexus injuries, particularly lower root avulsions, often result in paralyzed hands with poor functional restoration after primary reconstruction.
- Free muscle transfers, specifically gracilis muscle transplants, represent a critical option for hand reanimation in these severe cases.
Purpose of the Study:
- To analyze the outcomes of free gracilis muscle transfers for hand reanimation in patients with severe brachial plexus injuries.
- To evaluate the effectiveness of different motor donors in achieving functional hand restoration.
Main Methods:
- A retrospective analysis of 71 free gracilis muscle transfers performed for hand reanimation since 1981.
- Transfers were categorized for finger flexion (38 cases) or extension (33 cases).
- Neurotization utilized various motor donors including intercostal nerves, contralateral C7 root, spinal accessory nerve, and ipsilateral upper plexus roots.
Main Results:
- Significant improvements in preoperative and postoperative muscle grading and range of motion were observed.
- The distal spinal accessory nerve demonstrated the strongest outcomes for finger extension.
- Intercostal nerves were effective for finger flexion, and the contralateral C7 root for finger extension.
- The medial antebrachial cutaneous nerve as a conduit yielded poorer results; scar formation was a common complication.
Conclusions:
- Hand reanimation should be considered after proximal upper limb stability is achieved, especially in compliant patients with flexible finger joints.
- Successful hand reanimation can significantly improve the utility of a paralyzed limb, transforming it into a functional assist extremity.
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