Use of a free-functioning muscle transfer from a paralyzed lower extremity to restore upper extremity elbow flexion

This report documents the use of a free-functioning gracilis muscle transfer from a lower extremity paralyzed from a spinal cord injury to restore elbow flexion in the patient's upper extremity which was paralyzed from a brachial plexus injury. The transfer was performed nine months after injury and resulted in functional elbow flexion. Clinical examination and EMG analysis document function of the transferred muscle with grade 4 muscle strength. The resultant effect on the skeletal muscle is different after upper motor neuron injury versus lower motor neuron injury. The successful function of a free-functioning muscle transfer after a spinal cord injury in this case has important implications for patients with spinal cord injury.