title: Double free gracilis muscle transfer after complete brachial plexus injury: First Canadian experience.
abstract: Traumatic brachial plexus root avulsions are devastating injuries, and are complex and challenging to reconstruct. Double free muscle transfer using the gracilis muscles is a potentially effective method of restoring upper extremity function. The authors report on the first two patients treated using this technique in Canada. Both sustained traumatic brachial plexus root avulsion injuries resulting in a flail arm. In the first step of this two-stage procedure, a gracilis muscle was transferred to restore elbow flexion, and wrist and digit extension. Months later, the transfer of the second gracilis muscle was performed to enhance elbow flexion and to enable wrist and digit flexion. Postoperatively, both patients achieved Medical Research Council grade 4 elbow flexion, functional handgrip and were able to return to gainful employment. Patient satisfaction was high and active range of motion improved substantially. The authors' experience supports the use of this technique following severe brachial plexus injury.
authors.affiliation: Division of Plastic Surgery, University of Alberta, Edmonton, Alberta.
authors.forename: Kate
authors.initials: K
authors.lastname: Elzinga
authors.affiliation: Centre for Neuroscience, University of Alberta, Edmonton, Alberta.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Zuo
authors.affiliation: Division of Plastic Surgery, University of Alberta, Edmonton, Alberta.
authors.forename: Jaret L
authors.initials: JL
authors.lastname: Olson
authors.affiliation: Division of Plastic Surgery, University of Alberta, Edmonton, Alberta.
authors.forename: Michael
authors.initials: M
authors.lastname: Morhart
authors.affiliation: Centre for Neuroscience, University of Alberta, Edmonton, Alberta.
authors.forename: Sasha
authors.initials: S
authors.lastname: Babicki
authors.affiliation: Centre for Neuroscience, University of Alberta, Edmonton, Alberta ; Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Alberta.
authors.forename: K Ming
authors.initials: KM
authors.lastname: Chan
keywords: Brachial plexus injury; Double free muscle flap transfer; Flail arm; Functional muscle flap; Gracilis muscle flap