Lower Trapezius Muscle Transfer for Elbow Extension Reconstruction After Failed Nerve Transfer for Tetraplegia

Reconstruction of elbow extension is a first priority in the surgical management of patients with tetraplegia. Traditionally, posterior deltoid and biceps to triceps muscle transfers were used, but in recent years, nerve transfers have become the preferred choice of a few surgeons. However, nerve transfer reconstruction failures exist, often related to poor donor nerves, prolonged intervals between the injury and surgery, and advanced patient age. As a valid surgical alternative in such cases, we propose transferring the lower trapezius muscle to reconstruct elbow extension, because this procedure is already being performed successfully in patients with brachial plexus injury. We report 2 patients in whom a lower trapezius transfer was employed as a successful salvage procedure after failed nerve transfer surgery.