Functioning free muscle transplantation for brachial plexus injury.
Sixty-four cases of functioning free muscle transplantation to reconstruct brachial plexus injuries were reviewed for the years 1986 to 1991. Results were assessed using the Medical Research Council grading system, and success was defined as a muscle strength rating of 4 (ability to lift at least 1 kg). Functioning free muscle transplantation for shoulder abduction was ineffective because of its complex requirements. Functioning free muscle transplantation for biceps replacement using 2 or 3 intercostal nerves for innervation is a recommended procedure (success rate, to 80%). For function below the elbow, an intercostal nerve or spinal accessory (XI) nerve to innervate the functioning free muscle transplantation in flexor digitorum profundus replacement was inadequate. A new strategy for functions below the elbow was developed as a staged operation. The first operative stage involved either transfer of the ipsilateral upper trunk (in cases with lower plexus avulsion injury associated with upper trunk rupture) or contralateral C7 spinal nerve (in cases with total root avulsion injury) to the selected paralytic nerve. The second stage involved functioning free muscle transplantation, such as biceps or flexor digitorum profundus replacement for special function. No functioning free muscle transplantation for triceps or intrinsic hand function was tried.
Chuang
D C
DC
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan.
D000055:Accessory Nerve / Q000637:transplantation; D000293:Adolescent; D000328:Adult; D001917:Brachial Plexus / Q000293:injuries* / Q000601:surgery; D004550:Elbow / Q000503:physiopathology; D005385:Fingers / Q000503:physiopathology; D006801:Humans; D007367:Intercostal Nerves / Q000637:transplantation; D008297:Male; D018482:Muscle, Skeletal / Q000294:innervation / Q000637:transplantation*; D009138:Musculocutaneous Nerve / Q000601:surgery; D012421:Rupture; D012782:Shoulder / Q000503:physiopathology