• Marcelo R De Rezende, Bruno A Veronesi, Renata G Paulos, Alvaro B Cho, Samuel Ribak, and Rames M Junior.
• 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.rezende@hc.fm.usp.br.
• Int Orthop. 2021 Mar 1; 45 (3): 689-696.

PurposeIn 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.MethodsThis 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.ResultsAn 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).ConclusionIn 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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