Free Functional Muscle Transfer for Reconstruction after Brachial Plexus Injuries – Our Experience

Introduction: Free Functional Muscle Transfer (FFMT) is a salvage reconstructive procedure in patients with brachial plexus injury. FFMT may be used in late presentations with absent function, after failed prior nerve surgery or in cases with avulsion of four or more nerve roots. In FFMT, a long muscle with a proximally located neurovascular pedicle, such as the gracilis, is preferred. A gracilis transfer can be used to animate the elbow, wrist or hand. An intra-plexus or extra-plexus nerve transfer is used for innervation.

Methods: We retrospectively reviewed all patients treated with FFMT for brachial plexus injuries from Jan 2008 to May 2015, both for primary or secondary reconstructions, and at least one documented follow up visit 12 months or later after the surgery. Digital charts were reviewed including pre-treatment outpatient clinical reports, surgical reports and post-treatment outpatient clinic reports.

Results: Between January 2008 and May 2014, A total of 5 patients were treated with 6 FFMT`s for secondary reconstruction after brachial plexus injuries. One patient was treated after adult brachial plexus injury and five after obstetric brachial plexus injuries. 3 of the FFMT`s were used for reconstruction of elbow flexion, 2 for finger flexion and one for finger extension. 5 of the FFMT`s performed well (1 MRC grade 3 and 4 MRC grade 4). In 2 cases, the same donor nerves after a failed biceps neurotization procedure were used. Of these two cases one FFMT has failed to animate the elbow.

Discussion: FFMT is a reliable and predictable option for reconstruction after brachial plexus. Using the donor nerve after failed neurotization procedure is a viable option with less predictable results