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48. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 55. Jahrestagung der Österreichischen Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie (ÖGPÄRC), 22. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC)

14.09. - 16.09.2017, Graz, Österreich

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Free functioning gracilis muscle transfer with and without simultaneous intercostal nerve transfer to musculocutaneous nerve for restoration of elbow flexion after traumatic adult brachial pan-plexus injury

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  • presenting/speaker Andres A. Maldonado - BG Unfallklinik Frankfurt, Plastische Chirurgie, Frankfurt a. M., Deutschland; Mayo Clinic, Rochester, MN, Vereinigte Staaten
  • Michelle Kircher - Mayo Clinic, Rochester, MN, Vereinigte Staaten
  • Robert J. Spinner - Mayo Clinic, Rochester, MN, Vereinigte Staaten
  • Allen T. Bishop - Mayo Clinic, Rochester, MN, Vereinigte Staaten
  • Alexander Y. Shin - Mayo Clinic, Rochester, MN, Vereinigte Staaten

Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen. Österreichische Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie. Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen. 48. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 55. Jahrestagung der Österreichischen Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie, 22. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC). Graz, Österreich, 14.-16.09.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. Doc004

doi: 10.3205/17dgpraec004, urn:nbn:de:0183-17dgpraec0046

Published: August 16, 2017

© 2017 Maldonado et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Purpose: After complete five level root avulsion brachial plexus injury, free functional muscle transfer (FFMT) and intercostal nerve transfer (ICN) to musculocutaneous nerve (MCN) are two potential reconstructive options for restoration of elbow flexion. The aim of this study is to determine if the combination of gracilis FFMT and ICN to MCN transfer provides stronger elbow flexion compared to gracilis FFMT alone.

Methods: Sixty-five patients who underwent gracilis FFMT only (32 patients) or gracilis FFMT in addition to ICN to MCN transfer (33 patients) for elbow flexion following a pan-plexus injury were included. The two groups were compared with respect to postoperative elbow flexion strength according to the modified British Medical Research Council (BMRC) grading system as well as preoperative and postoperative DASH scores. Two subgroup analyses were performed for the BMRC elbow flexion strength grade: FFMT neurotization donor nerves (spinal accessory nerve orvs. ICN), FFMT) and the attachment of the distal gracilis tendon attachment (biceps ortendon vs. FDP/FPL tendon) as well as demographic characteristics were evaluated with a multivariate analysis.).

Results: The proportion of patients reaching M3/M4 elbow flexion muscle grade were similar in both groups (FFMT vs. FFMT + ICN to MCN transfer). Lower BMI and the FFMT distal attachment to the FDP/FPL tendon were independently associated with M3 or M4 elbow flexion.). Statistically significant improvement in postoperative DASH score was found in the FFMT + ICN to MCN transfer group but not in the FFMT group. There was a significant difference between gracilis to biceps (M3/M4 = 52.6%) versus gracilis to FDP/FPL (M3/M4 = 85.2%) tendon attachment.

Conclusion: The use of ICN to MCN transfer associated with FFMT does not improve the elbow flexion modified BMRC grade, although better postoperative DASH scores were found in this group. The more distal attachment of the gracilis FFMT tendon may play an important role in elbow flexion strength.