title: Donor nerve sources in free functional gracilis muscle transfer for elbow flexion in adult brachial plexus injury.
abstract: BACKGROUND
  With complete plexus injuries or late presentation, free functional muscle transfer (FFMT) becomes the primary option of functional restoration. Our purpose is to review cases over a 10-year period of free functioning gracilis muscle transfer after brachial plexus injury to evaluate the effect of different donor nerves used to reinnervate the FFMT on functional outcome.
  
  
  METHODS
  A retrospective study from April 2001 to January 2011 of a single surgeon's practice was undertaken. During this time period 22 patients underwent FFMT at Washington University in St Louis, Missouri for elbow flexion.
  
  
  RESULTS
  Thirteen patients for whom FFMT was performed for elbow flexion met all of the requirements for inclusion in this study. Average time from injury to first operation was 12.8 months (range 4-60), and average time from injury to FFMT was 29 months (range 8-68). Average follow-up was 31.8 months (range 11-84). The nerve donors utilized included the distal accessory nerve, intercostal with or without rectus abdominis nerves, medial pectoral nerves, thoracodorsal nerve, and flexor carpi ulnaris fascicle of ulnar nerve. Functional recovery of elbow flexion was measured using the MRC grading system which showed 1 M5/5, 5 M4, 4 M3, and 3 M2 outcomes.
  
  
  CONCLUSIONS
  Intraplexal donor motor nerves if available will provide better transferred muscle function because they are higher quality donors closer to the muscle and can be done in one stage without a nerve graft. Otherwise, intercostal, rectus abdominis, or the distal accessory nerve should be used in a staged fashion. © 2016 Wiley Periodicals, Inc. Microsurgery 37:377-382, 2017.
authors.affiliation: Hand + Wrist of Louisville, Louisville, KY, 40223, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Nicoson
authors.affiliation: Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Franco
authors.affiliation: Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Tung
mesh_terms: D000055:Accessory Nerve / Q000637:transplantation; D000328:Adult; D001917:Brachial Plexus / Q000293:injuries* / Q000503:physiopathology; D004551:Elbow Joint / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000294:innervation* / Q000637:transplantation; D000071976:Gracilis Muscle / Q000294:innervation / Q000637:transplantation*; D006801:Humans; D007367:Intercostal Nerves / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D016067:Nerve Transfer / Q000379:methods*; D059348:Peripheral Nerve Injuries / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D017568:Rectus Abdominis / Q000294:innervation; D012189:Retrospective Studies; D013900:Thoracic Nerves / Q000637:transplantation; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000637:transplantation
keywords: brachial plexus; elbow flexion; free functional muscle transfer; gracilis muscle