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Free gracilis muscle transfer with ulnar nerve neurotization for elbow flexion restoration

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Abstract

Purpose

In upper and chronic brachial plexus injuries for which neurological surgery is not a good treatment option, one possibility for gaining elbow flexion is free functional muscle transfer. The primary aim of our study was to evaluate the elbow flexion gain achieved by free gracilis muscle transfer with partial ulnar nerve neurotization.

Methods

This surgery was performed in 21 patients with upper and chronic (> 12 months) brachial plexus injuries. The level of injury, patient age, the time between trauma and surgery, the affected side, and the aetiology of the lesion were recorded. The primary outcome evaluated was elbow flexion muscle strength, which was measured using the British Medical Research Council (BMRC) scale, in patients with a minimum follow-up period of 12 months. The criterion used to classify elbow flexion as good was a grade of M4 or higher.

Results

An M4 elbow flexion strength gain was observed in 61.9% of the patients. A gain of M2 or higher was observed in 95.2% of the patients. The mean range of active motion was 77° (range 10 minimum–110 maximum).

Conclusion

In patients with upper and chronic brachial plexus injuries, free gracilis muscle transfer with ulnar nerve neurotization yields a satisfactory gain in elbow flexion strength and is therefore a good treatment option.

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Data availability

Study data are available in a Microsoft Excel spreadsheet.

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Authors and Affiliations

  1. Department of Hand Surgery and Microsurgery, Institute of Orthopedics and Traumatology of the Clinics Hospital, School of Medicine, University of São Paulo (IOT-HCFMUSP), Ovídio Pires de Campos, 333, Cerqueira César, São Paulo, SP, 05403-010, Brazil

    Marcelo R. De Rezende, Bruno A. Veronesi, Renata G. Paulos, Alvaro B. Cho, Samuel Ribak & Rames M. Junior

Authors
  1. Marcelo R. De Rezende
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  2. Bruno A. Veronesi
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  3. Renata G. Paulos
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  4. Alvaro B. Cho
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  5. Samuel Ribak
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  6. Rames M. Junior
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Contributions

Each author provided significant individual contributions to this manuscript. MRR performed surgeries and wrote, updated, and reviewed the article. BAV wrote and updated the article, analyzed study data, and revised the manuscript. RGP and ABC performed surgeries and reviewed the article. SR and RMJ conducted statistical analysis and reviewed the article. All of the authors contributed to the intellectual concept of the study and approved the final version of the manuscript.

Corresponding author

Correspondence to Marcelo R. De Rezende.

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Conflict of interest/competing interests

The authors declare that they have no conflicts of interest.

Ethics approval

This study was approved by the relevant institutional review board and registered on the Plataforma Brasil database (CAAE (Ethics Evaluation Submission Certificate) number 43085215.1.0000.0068).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

All of the patients signed an informed consent regarding publication of this study.

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Not applicable.

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De Rezende, M.R., Veronesi, B.A., Paulos, R.G. et al. Free gracilis muscle transfer with ulnar nerve neurotization for elbow flexion restoration. International Orthopaedics (SICOT) 45, 689–696 (2021). https://doi.org/10.1007/s00264-020-04873-7

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  • DOI: https://doi.org/10.1007/s00264-020-04873-7

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