Free functioning gracilis transfer for traumatic brachial plexus injuries in children

Area of Science:

• Reconstructive surgery
• Pediatric orthopedics
• Microsurgery

Background:

• Traumatic brachial plexus injuries (BPIs) in children can lead to significant functional deficits.
• Restoration of arm function is crucial for quality of life in pediatric patients.
• Free functioning muscle transfer (FFMT) is a reconstructive option for severe BPIs.

Purpose of the Study:

• To evaluate the technique, outcomes, and complications of FFMT in pediatric patients with traumatic BPIs.
• To assess the efficacy of gracilis muscle transfer for restoring elbow flexion and prehension.
• To analyze functional recovery and range of motion following FFMT.

Main Methods:

• A retrospective review of 12 pediatric patients with complete BPIs who underwent FFMT between 2000 and 2012.
• Single-stage or double free gracilis muscle transfer was performed for elbow flexion and/or prehension.
• Mean follow-up duration was 27 months, with functional outcomes assessed using established grading systems.

Main Results:

• Eleven of 12 patients achieved M3 or greater elbow flexion strength, with 8 reaching M4 or higher.
• Mean active elbow range of motion was 79 degrees.
• Two patients with open growth plates developed elbow contractures but regained significant elbow flexion strength.

Conclusions:

• FFMT can yield favorable functional outcomes in the reconstruction of traumatic BPIs in children.
• The risk of elbow flexion contractures necessitates careful consideration of FFMT in skeletally immature patients.
• FFMT is a viable option for restoring function after pediatric BPIs, with potential for good strength recovery.