title: Reliability of functioning free muscle transfer and vascularized ulnar nerve grafting for elbow flexion in complete brachial plexus palsy.
abstract: We compared outcomes of primary vascularized ulnar nerve grafts from the C5 root neurotizing biceps and brachialis muscles, and gracilis functioning free muscle transfer neurotized by the distal spinal accessory nerve, as a primary or salvage procedure after complete brachial plexus injury. At 45 months, three of eight primary vascularized ulnar nerve graft patients regained grade 4 elbow flexion, while one regained grade 3. All 13 primary gracilis transfer patients regained grade 4 elbow flexion. Four patients with vascularized ulnar nerve grafts failed and subsequently had salvage functioning free muscle transfer procedures resulting in delayed recovery. Although vascularized ulnar nerve graft-based primary reconstructions can provide useful elbow flexion, this was achieved in less than half the cases. We consider primary gracilis functioning free muscle transfer neurotized by the distal spinal accessory nerve as the most reliable reconstruction for the restoration of elbow flexion in complete brachial plexus injury.
  
  
  METHODS
  IV.
authors.affiliation: 1 Victorian Plastic Surgery Unit, St Vincent's Private Hospital, East Melbourne, Victoria, Australia.|2 Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred Hospital, Prahan, Victoria, Australia.
authors.forename: S M
authors.initials: SM
authors.lastname: Potter
authors.affiliation: 1 Victorian Plastic Surgery Unit, St Vincent's Private Hospital, East Melbourne, Victoria, Australia.|2 Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred Hospital, Prahan, Victoria, Australia.
authors.forename: S I
authors.initials: SI
authors.lastname: Ferris
mesh_terms: D000328:Adult; D001917:Brachial Plexus / Q000293:injuries* / Q000601:surgery; D020516:Brachial Plexus Neuropathies / Q000601:surgery*; D004551:Elbow Joint / Q000502:physiology; D000071976:Gracilis Muscle / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016067:Nerve Transfer / Q000379:methods; D016059:Range of Motion, Articular; D018709:Statistics, Nonparametric; D014459:Ulnar Nerve / Q000098:blood supply / Q000637:transplantation*; D055815:Young Adult
keywords: Brachial plexus injury; elbow flexion; functioning free muscle transfer; gracilis muscle; nerve graft; vascularized ulnar nerve graft