Free muscle transfer in posttraumatic plexopathies: part 1: the shoulder

Area of Science:

• Orthopedic Surgery
• Microsurgery
• Reconstructive Surgery

Background:

• Microsurgical restoration of shoulder abduction using free muscle transfers presents significant reconstructive challenges.
• Posttraumatic brachial plexopathy often necessitates complex surgical interventions to regain shoulder function.

Purpose of the Study:

• To retrospectively analyze the outcomes of free muscle transfer procedures for shoulder abduction restoration.
• To evaluate the effectiveness of different free muscle transfer techniques in patients with posttraumatic brachial plexopathy.

Main Methods:

• Retrospective analysis of 22 free muscle transfers performed since 1981 for shoulder abduction in posttraumatic brachial plexopathy.
• Comparison of two techniques: double muscle transfer (adductor longus and gracilis) for 18 patients and latissimus dorsi transfer for 4 patients.

Main Results:

• Double muscle transfer group: Mean shoulder abduction of 30 +/- 24 degrees and mean muscle grade of 2.61 +/- 0.76 (P < 0.001).
• Latissimus dorsi transfer group: Mean muscle grade of 3.25 +/- 0.73 and mean shoulder abduction of 40 +/- 32 degrees.
• Overall, all patients achieved a stable shoulder; 53% achieved abduction against gravity, and 9% reached horizontal abduction.

Conclusions:

• Free muscle transfer is a valuable option for enhancing shoulder abduction, particularly after failed primary reconstructions or in late-stage cases.
• The study demonstrates the potential of microsurgical free muscle transfer to improve shoulder function and stability in challenging clinical scenarios.