Restoration of Grasp after Single-Stage Free Functioning Gracilis Muscle Transfer In Traumatic Adult Pan Brachial Plexus Injury.

INTRODUCTION: A variety of approaches have been described to obtain rudimentary grasp following traumatic pan brachial plexus injury in the adult. The aim of this study is to evaluate hand prehension after a Gracilis Single-Stage Free Functioning Muscle Transfer (SSFFMT).

MATERIALS AND METHODS: Twenty-seven patients who underwent gracilis SSFFMT for elbow flexion and hand prehension following a pan-plexus injury were included. All patients presented with a minimum of 2 years of follow-up. Postoperative finger flexion, elbow flexion strength, preoperative and postoperative DASH scores, secondary hand procedures, complications as well as demographic characteristics were analyzed.

RESULTS: Twenty patients (74%) demonstrated active finger pull-through. Only 6 (25%) patients considered their hand function as useful for daily activities. DASH score improved by 13.1 ± 13.7 (p-value < 0.005). All patients were expected to require one secondary procedure: combined wrist, thumb CMC and thumb IP fusions, as no extensor reconstruction was performed. These were actually performed in 89%, 78% and 74% of patients, respectively. Four postoperative complications included hematoma, seroma, wound dehiscence and skin paddle loss. No flap loss occurred.

CONCLUSION: In pan-plexus injuries, the use of a gracilis SSFFMT is an alternative to the Doi double FFMT procedure and cC7 transfer, especially for patients that cannot afford (economically or mentally) two to three important surgeries in a short period of time. Further research and studies are required to improve hand function in these patients.