Free muscle graft as applied to brachial plexus injury-case report and experimental study

Active flexion of the elbow was restored in a case with complete brachial plexus injury of ten years' standing, by using free gracilis muscle graft with restoration of its vascular pedicle and the 3rd and 4th intercostal nerves for reinnervation of the graft. Experimental studies on the anterior tibial muscle of rats showed that the major bulk of the proximal part of the muscle by preservation of neuro-vascular bundle survived and was histologically viable, whereas, the major bulk of the distal part of the muscle replaced as a free graft necrosed and was replaced by fibrosis. A free graft with its intact circulation and neural supply could therefore provide a good proportion of viable muscle bulk for functional restoration in properly selected cases.