Double free-muscle transfer to restore prehension following complete brachial plexus avulsion

Doi, Kazuteru; Sakai, Kazuhiro; Kuwata, Noriyuki; Ihara, Kenji; Kawai, Shinya

doi:10.1016/s0363-5023(05)80097-8

Cited by 128 publications

(71 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…At 10 kg and 5 kg, respectively, our patients are comparable with the average lift strength reported by Doi et al (3). Perhaps more importantly, patient self-reported performance and satisfaction with upper extremity function improved significantly following DFMT.…”

Section: Discussionsupporting

confidence: 87%

See 1 more Smart Citation

Double free gracilis muscle transfer after complete brachial plexus injury: First Canadian experience

Elzinga¹,

Zuo²,

Olson³

et al. 2014

CAN J PLAST SURG

View full text Add to dashboard Cite

T raumatic brachial plexus injuries can result in devastating and debilitating motor and sensory deficits. Among these, global root avulsion injuries are associated with the worst prognosis and are highly challenging to reconstruct (1). Even the results of extraplexal nerve transfers are modest at best because donor nerve options are limited and the time window for surgery is extremely narrow (2).A potentially viable alternative is double free muscle transfer (DFMT), a procedure first described by Doi et al (3) in Japan to improve shoulder stability, elbow flexion and extension and, importantly, hand prehension. Outside of Japan, however, experience with this procedure is limited and reports on functional outcomes are scant. Herein, we report the functional outcomes of the first two cases in Canada of patients with severe brachial plexus injuries treated using DFMT. The present study was approved by the University of Alberta Research Ethics Board (Edmonton, Alberta) and both patients provided informed written consent for their participation in the research and the publication of their information. Case presentationsPatient 1 was an 18-year-old right-handed man involved in a motor vehicle accident that resulted in a complete left brachial plexus avulsion injury and a flail arm. The left gracilis muscle was used in the first stage of the DFMT five months postinjury to restore elbow flexion and finger extension. Once dissected, the gracilis was marked in situ at 5 cm intervals with methylene blue. It was harvested with a 6 cm vascular pedicle (ascending branch of the medial circumflex femoral artery and venae comitantes) and an 8 cm nerve (obturator nerve). Flap inset into the arm was performed using the same 5 cm intervals to assure the proper muscle length and tension with the elbow in 45° of flexion, forearm supination, and the wrist, metacarpophalangeal and interphalangeal joints in neutral position. The gracilis was then secured proximally to the anterior surface of the lateral clavicle, tunnelled through the flexor compartment of the upper arm and under the mobile wad at the elbow, and sutured distally to the extensor digitorum communis and extensor pollicis longus tendons ( Figure 1A). The spinal accessory nerve was neurotized to the recipient obturator nerve. The gracilis vessels were anastomosed to the thoracoacromial artery and vein.The second free muscle transfer was performed 11 months postinjury to further enhance elbow flexion and to restore wrist and finger flexion. The right free gracilis muscle was harvested and then secured proximally to the second rib and distally to the flexor digitorum profundus and flexor pollicis longus tendons ( Figure 1B). The gracilis vessels were anastomosed to the thoracodorsal artery and vein, and the obturator nerve was neurotized to the third, fourth and fifth intercostal motor nerves just proximal and lateral to the axilla. To improve the range of motion of the digits, tenolysis was subsequently performed to release tendon adhesions between the gracilis flap and the...

show abstract

Section: Discussionsupporting

confidence: 87%

“…DFMT was first described by Doi et al (3) in 1995 as a strategy to restore multiple functions, including rudimentary hand grip and release. Reinnervation of the transferred muscle is usually detectable by EMG within three to eight weeks, with voluntary contraction appearing an additional two months later (3).…”

Section: Discussionmentioning

confidence: 99%

Double free gracilis muscle transfer after complete brachial plexus injury: First Canadian experience

Elzinga¹,

Zuo²,

Olson³

et al. 2014

CAN J PLAST SURG

View full text Add to dashboard Cite

show abstract

“…103 More than 1 muscle transfer is often needed to re-establish function in complete avulsion of the brachial plexus. In addition to multiple muscle transfers, Doi et al 104,105 described the use of a single long muscle across the elbow for simultaneous restoration of elbow function and finger extension or flexion. Free functional muscle transfer exemplifies the central role that the microvascular surgeon has in upper extremity reconstruction.…”

Section: Brachial Plexus Surgerymentioning

confidence: 99%

Microsurgery of the Upper Extremity

Lerman

Haddock

Elliott

et al. 2011

The Journal of Hand Surgery

View full text Add to dashboard Cite

“…Neben den allgemeinen notwendigen Voraussetzungen für die Wiederherstellung einer insuffizienten oder fehlenden Muskelfunktion müssen zusätzliche Voraussetzungen und operationstechnische Details beachtet werden [2,3,11,16,18,19,30].…”

Section: Introductionunclassified

Free Functional Gracilis Muscle Transplantation for Reconstruction of Active Elbow Flexion in Posttraumatic Brachial Plexus Lesions

Berger

Hierner

2009

Orthop Traumatol

View full text Add to dashboard Cite

Functionally useful results can be expected in 60-75% of patients, especially if there is some residual function (M1 or M2) left ("augmentation indication"). Early free functional muscle transplantation shows best results in patients with direct muscle defect, because all vascular and neuronal structures are still available, and no secondary changes such as fibrosis or joint stiffness are present yet. There are inconsistent results for patients with neurologic insufficiency (i.e., total brachial plexus palsy) or mixed neuromuscular insufficiency, such as compartment syndrome. Especially in complete brachial plexus lesion, free functional muscle transfer is often the only treatment option. Provided there is a good patient selection, satisfactory results can be achieved for elbow flexion. Whether a higher number of axons, as provided by the contralateral C7 transfer, will lead to better results is the topic of an ongoing study.

show abstract

Double free-muscle transfer to restore prehension following complete brachial plexus avulsion

Cited by 128 publications

References 3 publications

Double free gracilis muscle transfer after complete brachial plexus injury: First Canadian experience

Double free gracilis muscle transfer after complete brachial plexus injury: First Canadian experience

Microsurgery of the Upper Extremity

Free Functional Gracilis Muscle Transplantation for Reconstruction of Active Elbow Flexion in Posttraumatic Brachial Plexus Lesions

Contact Info

Product

Resources

About