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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Free Gracilis Muscle Transfers Compared with Non-Free Muscle Transfer for Elbow Flexion Reanimation: A Meta-Analysis

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  • presenting/speaker Steven Koehler - SUNY Downstate Medical Center, Department of Orthopaedic Surgery, Hand and Microsurgery, Brooklyn, United States
  • Jared Newman - SUNY Downstate Medical Center, Department of Orthopaedic Surgery, Hand and Microsurgery, Brooklyn, United States
  • Erika Kuehn - SUNY Downstate Medical Center, Department of Orthopaedic Surgery, Hand and Microsurgery, Brooklyn, United States
  • Neil Shah - SUNY Downstate Medical Center, Department of Orthopaedic Surgery, Hand and Microsurgery, Brooklyn, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-20

doi: 10.3205/19ifssh1208, urn:nbn:de:0183-19ifssh12084

Published: February 6, 2020

© 2020 Koehler 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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Objectives/Interrogation: The hypothesis of the present study was that free gracilis muscle transfers will have similar results as compared to non-free muscle transfers (tendon transfers, nerve transfers, Steindler procedure, and pedicle muscle transfers) for elbow flexion reanimation.

Methods: A literature search was performed for randomized clinical trials and comparative studies that evaluated free gracilis muscle transfers versus non-free muscle transfers to the elbow published between the inception of the databases to January 2018. The outcomes included failure, which was defined as strength that was ≤ M3 (unable to raise arm against gravity) or acute loss of graft, range-of-motion (ROM), and Disabilities of the Arm, Shoulder and Hand (DASH) score. Studies were included if they had at least one of the outcomes of interest. To compare the two groups, the pooled odds ratios (OR) and 95% confidence intervals (95% CI) were used to calculate the failures, and the pooled mean differences (MD) and 95% CI were used to calculate differences in strength, ROM, and DASH scores.

Results and Conclusions: A total of 5 studies involving 294 patients were included for analysis. Compared to the non-free muscle transfer group, the gracilis free muscle transfer group had a lower failure rate (OR= 0.29; 95% CI, 0.13 to 0.61; p=0.001) (Figure 1 [Fig. 1]).

The gracilis free muscle transfer group had better strength compared to the non-free muscle transfer group, but this was not significant (MD= -0.12; 95% CI, -0.37 to 0.14; p=0.370). Also, when DASH scores were evaluated, there was a trend towards better scores in the gracilis free muscle transfer group, but this was not statistically significant (MD= -3.21; 95% CI, -14.01 to 7.59; p=0.560). In conclusion, both gracilis free muscle transfers and non-free muscle transfers to the elbow can have similar outcomes for reanimation of elbow flexion. The use of gracilis free muscle transfers had a significantly lower failure rate, but tended to have better strength and DASH scores compared to the non-free muscle transfer group, however, these were not statistically significant.