title: MICROSURGICAL TRANSFER OF THE GRACILIS MUSCLE FOR ELBOW FLEXION IN BRACHIAL PLEXUS INJURY IN ADULTS: RETROSPECTIVE STUDY OF EIGHT CASES.
abstract: OBJECTIVE
  Treating brachial plexus injuries is a major challenge, especially lesions that are presented late, with more than 12 months of evolution. We retrospectively analyzed patients who underwent one of the possibilities for attempting to restore the function of upper limbs affected under such conditions: microsurgical transfer of the gracilis muscle for elbow flexion.
  
  
  METHODS
  Eight patients were included, divided into two groups: one in which the procedure consisted of neurorrhaphy of the muscle flap with sural nerve grafting and anastomosis more distally; and the other, in which the neurorrhaphy was performed directly on the spinal accessory nerve, with anastomosis in thoracoacromial vessels.
  
  
  RESULTS
  We found a significant difference between the groups. A greater number of satisfactory results (75% M4) were found among patients who underwent direct neurorrhaphy, whereas the procedure using grafts for neurorrhaphy was less successful (25% M4).
  
  
  CONCLUSIONS
  Patients who underwent microsurgical functional transfer of the gracilis muscle in which vascular anastomoses were performed in thoracoacromial vessels presented better functional outcomes than shown by those whose anastomoses were in the brachial artery with subsequent use of a nerve graft.
authors.affiliation: Attending Physician in the Hand Group, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, SP, Brazil.
authors.forename: Luiz Koiti
authors.initials: LK
authors.lastname: Kimura
authors.affiliation: Resident Physician, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, SP, Brazil.
authors.forename: Alexandre Tadeu
authors.initials: AT
authors.lastname: do Nascimento
authors.affiliation: Resident Physician, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, SP, Brazil.
authors.forename: Roberto
authors.initials: R
authors.lastname: Capócio
authors.affiliation: Associate Professor in the School of Medicine, USP; Head of the Hand Group, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, SP, Brazil.
authors.forename: Rames
authors.initials: R
authors.lastname: Mattar
authors.affiliation: Attending Physician in the Hand Group, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, SP, Brazil.
authors.forename: Marcelo Rosa
authors.initials: MR
authors.lastname: Rezende
authors.affiliation: Attending Physician in the Hand Group, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, SP, Brazil.
authors.forename: Teng Hsiang
authors.initials: TH
authors.lastname: Wei
authors.affiliation: Attending Physician in the Hand Group, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, SP, Brazil.
authors.forename: Luciano Ruiz
authors.initials: LR
authors.lastname: Torres
authors.affiliation: Collaborating Physician in the Hand Group, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, SP, Brazil.
authors.forename: Fernando Munhoz
authors.initials: FM
authors.lastname: Moya
keywords: Brachial Plexus; Elbow; Microsurgery