title: Evaluation of elbow flexion following free muscle transfer from the medial gastrocnemius or transfer from the latissimus dorsi, in cases of traumatic injury of the brachial plexus.
abstract: OBJECTIVE
  To compare the gain in elbow flexion in patients with traumatic injury of the brachial plexus following muscle transfer from latissimus dorsi with the gain following free muscle transfer from the medial belly of the gastrocnemius.
  
  
  METHODS
  This was a retrospective study in which the medical files of a convenience sample of 13 patients operated between 2000 and 2010 were reviewed. Group 1 comprised seven patients who underwent transfers from the gastrocnemius and group 2 (controls) comprised six patients who underwent transfers from the latissimus dorsi. The following functions were evaluated: (1) range of motion (ROM) of elbow flexion, in degrees, using manual goniometry and (2) grade of elbow flexion strength, using a muscle strength scale. Satisfactory results were defined as: (1) elbow flexion ROM ≥ 80° and (2) elbow flexion strength ≥ M3. The Fisher exact and Kruskal-Wallis tests were used (p < 0.05).
  
  
  RESULTS
  The patients' mean age was 32 years (range: 17-56) and 72% had been involved in motorcycle accidents. Elbow flexion strength ≥ M3 was observed in seven patients (100%) in group 1 and in five patients (83.3%) in group 2 (p = 0.462). None of the patients presented M5, and one patient (16.7%) in group 2 had a poor result (M2). Elbow flexion ROM with a gain ≥ 80° (daily functions) was found in six patients (86%) in group 1 and in three patients (50%) in group 2 (p = 0.1).
  
  
  CONCLUSIONS
  The patients in group 1 had greater gains in strength and ROM than did those in group 2, but without statistical significance. Thus, transfers from the gastrocnemius become a new surgical option, if other techniques cannot be used.
authors.affiliation: Department of Orthopedics and Traumatology, Faculdade de Medicina, Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil.
authors.forename: Frederico Barra
authors.initials: FB
authors.lastname: de Moraes
authors.affiliation: Department of Orthopedics and Traumatology, Faculdade de Medicina, Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil.
authors.forename: Mário Yoshihide
authors.initials: MY
authors.lastname: Kwae
authors.affiliation: Department of Orthopedics and Traumatology, Faculdade de Medicina, Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil.
authors.forename: Ricardo Pereira
authors.initials: RP
authors.lastname: da Silva
authors.affiliation: Department of Orthopedics and Traumatology, Faculdade de Medicina, Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil.
authors.forename: Celmo Celeno
authors.initials: CC
authors.lastname: Porto
authors.affiliation: Department of Orthopedics and Traumatology, Faculdade de Medicina, Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil.
authors.forename: Daniel
authors.initials: D
authors.lastname: de Paiva Magalhães
authors.affiliation: Department of Orthopedics and Traumatology, Faculdade de Medicina, Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil.
authors.forename: Matheus Veloso
authors.initials: MV
authors.lastname: Paulino
keywords: Brachial plexus/surgery; Muscle/transplant; Reconstructive surgical procedures