Functioning free muscle transplantation for brachial plexus injury

¹Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan.

|May 1, 1995

Summary

Functioning free muscle transplantation shows promise for biceps reconstruction in brachial plexus injuries, achieving up to 80% success. However, it

Area of Science:

Background:

Brachial plexus injuries often result in significant functional deficits.
Reconstructive surgery aims to restore function, with functioning free muscle transplantation (FFMT) being a key technique.

Purpose of the Study:

To evaluate the efficacy of FFMT for various upper extremity reconstructions in brachial plexus injuries.
To identify optimal nerve donors and surgical strategies for successful functional restoration.

Main Methods:

A retrospective review of 64 cases of FFMT for brachial plexus injuries (1986-1991).
Outcomes assessed using the Medical Research Council (MRC) grading system, with success defined as MRC grade 4 strength.
Analysis of different muscle targets (shoulder abduction, biceps, flexor digitorum profundus) and nerve innervations (intercostal, spinal accessory, C7 nerve transfers).

Main Results:

FFMT for shoulder abduction was ineffective.
FFMT for biceps replacement using intercostal nerves demonstrated an 80% success rate.
Intercostal or spinal accessory nerve grafts were inadequate for flexor digitorum profundus (FDP) replacement.
A two-stage strategy involving nerve transfers followed by FFMT was developed for below-elbow function.

Conclusions:

FFMT is a viable and recommended option for biceps reconstruction in brachial plexus injuries, particularly when innervated by intercostal nerves.
Restoring function below the elbow requires a staged approach, combining nerve transfers with FFMT.
Further research is needed to optimize FFMT for triceps and intrinsic hand function reconstruction.

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