title: Free gracilis transfer reinnervated by the nerve to the supinator for the reconstruction of finger and thumb extension in longstanding C7-T1 brachial plexus root avulsion.
abstract: OBJECTIVE
  To report the clinical results of a free gracilis muscle transfer to finger and thumb extensors reinnervated by supinator muscle motor branches in patients with longstanding C7-T1 root avulsion.
  
  
  METHODS
  Between January 2010 and January 2011, 3 young adult patients with traumatic C7-T1 brachial plexus palsies had gracilis transfer to the thumb and finger extensors at a mean of 38 months after injury. The muscle flap was connected to radial vessels and comitant veins and to nerve branches supplying the supinator muscle.
  
  
  RESULTS
  All patients had recovery of active thumb and finger extension, scoring M3 and M4 on the Medical Research Council scale, respectively, at a mean of 12 months after surgery.
  
  
  CONCLUSIONS
  Reconstruction of finger and thumb extension in lower-type brachial plexus injuries is a challenging problem that is most commonly addressed with an extensor tenodesis technique, which depends on wrist flexion. Free gracilis transfer innervated by nerve branches to the supinator provided the restoration of thumb and finger extension independent of wrist flexion.
  
  
  CONCLUSIONS
  For those patients with lower brachial root injury more than a year old, transfer of a free functional gracilis muscle is an alternative for the reconstruction of thumb and finger extension.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Pediatric Upper Extremity Surgery and Microsurgery Department, Universitat Autonoma de Barcelona, Barcelona, Spain. drsoldado@cirugiamanoinfantil.com
authors.forename: Francisco
authors.initials: F
authors.lastname: Soldado
authors.forename: Jayme
authors.initials: J
authors.lastname: Bertelli
mesh_terms: D000328:Adult; D020516:Brachial Plexus Neuropathies / Q000601:surgery*; D005260:Female; D005385:Fingers / Q000294:innervation*; D006801:Humans; D008297:Male; D016067:Nerve Transfer / Q000379:methods*; D020127:Recovery of Function; D013126:Spinal Nerve Roots / Q000293:injuries*; D013933:Thumb / Q000294:innervation*; D055815:Young Adult