Reliability of functioning free muscle transfer and vascularized ulnar nerve grafting for elbow flexion in complete brachial plexus palsy

Potter, Shirley; Ferris, Scott

doi:10.1177/1753193417702029

Cited by 23 publications

(26 citation statements)

References 26 publications

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“…Five studies reported data of graft failures. [7][8][9]13,16 Four suggested lower failure rates with free muscle transfers utilizing the gracilis than with nonfree muscle transfers, [7][8][9]16 and one had no incidences of graft failure. 13 Pooled results indicated that compared with the nonfree muscle transfer group, the gracilis FFMT group had significantly lower odds of failure (OR = 0.36; 95% CI, 0.19-0.69; p = 0.002) (►Fig.…”

Section: Resultsmentioning

confidence: 98%

“…Elbow flexion strength at final follow-up was recorded in four studies. Two studies indicated improved strength following FFMTs utilizing the gracilis compared with nonfree muscle transfers, 9,16 and two studies suggested increased flexion strength in the nonfree muscle transfer group. 7,13 Pooled data indicated that the FFMT group had a slightly larger MD in strength than the nonfree muscle transfer group had (MD = 0.02; 95% CI, 0.50 to 0.46; p = 0.94), though this difference was not statistically significant (►Fig.…”

Section: Resultsmentioning

confidence: 99%

“…ROM data at final follow-up was reported in two studies. 13,16 The studies had conflicting results regarding which treatment group recovered a greater arc of motion, and there was no significant difference between the FFMT and nonfree muscle groups in pooled MD (p = 0.83) (►Fig. 4).…”

Section: Resultsmentioning

confidence: 99%

“…DASH scores were reported in three studies, with one favoring the gracilis FFMT group 9 and two favoring the nonfree muscle transfer group. 11,16 Pooled data suggested that DASH scores were improved in the FFMT group, but MD between the groups was not significant (MD = 4.19; 95% CI, 10.94 to 2.55; p = 0.22) (►Fig. 5).…”

Section: Resultsmentioning

confidence: 99%

“…Its contractile fibers run parallel to the muscle's course, its artery and vein are of similar size to the thoracoacromial artery and cephalic vein, and removal of the muscle is not expected to cause noticeable functional deficit in the lower extremity. 12,16 Despite Free Gracilis Muscle Transfers Compared with Nonfree Muscle Flaps Scollan et al theoretical advantages, previous comparative studies have described conflicting data on free gracilis functionality and failure rates in comparison to nonfree muscle transfers. [7][8][9]11,13,16 The current literature does not contain a pooled report of expected outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Free Gracilis Muscle Transfers Compared with Nonfree Muscle Flaps for Reanimation of Elbow Flexion: A Meta-Analysis

Scollan

Newman

Shah

et al. 2020

Journal of Hand and Microsurgery

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Objectives Elbow flexion loss is a debilitating upper extremity injury. Surgical treatment options include nonfree muscle transfers (tendon transfers, nerve transfers, Steindler procedure, Oberlin transfers, and pedicled muscle transfers) or free muscle transfers. We sought to determine if free muscle transfers and nonfree muscle transfers have similar outcomes for elbow flexion reanimation. Materials and Methods A literature search for studies evaluating free and nonfree muscle transfers for elbow flexion reanimation was performed. Included studies reported on transfer failure (strength <M3, unable to flex arm against gravity), strength, range of motion (ROM), or Disabilities of the Arm, Shoulder, and Hand (DASH) score. Pooled odds ratios were used to calculate failure rate, and pooled mean differences were used to calculate differences in strength, ROM, and DASH scores. Results Six studies were included (n = 331 patients). Free muscle patients experienced lower failure rates than nonfree muscle patients. There was no significant difference in ROM. A nonsignificant trend toward better mean strength and DASH scores among free muscle patients was observed. Conclusion Free muscle transfers may be superior to nonfree muscle transfers for elbow flexion reanimation, given their lower failure rates. Well-powered future studies may reveal differences in strength and DASH scores between free and nonfree muscle transfers.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Free Gracilis Muscle Transfers Compared with Nonfree Muscle Flaps for Reanimation of Elbow Flexion: A Meta-Analysis

Scollan

Newman

Shah

et al. 2020

Journal of Hand and Microsurgery

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Elbow flexion reconstruction with nerve transfer or grafting in patients with brachial plexus injuries: A systematic review and comparison study

Ayhan

Soldado²,

Fontecha

et al. 2019

Microsurgery

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IntroductionPosttraumatic brachial plexus (BP) palsy was used to be treated by reconstruction with nerve grafts. For the last two decades, nerve transfers have gained popularity and believed to be more effective than nerve grafting. The aim of this systematic review was to compare elbow flexion restoration with nerve transfers or nerve grafting after traumatic BP injury.MethodsPRISMA‐IPD structure was used for 52 studies included. Patients were allocated as C5‐C6 (n = 285), C5‐C6‐C7 (n = 150), and total BP injury (n = 245) groups. In each group, two treatment modalities were compared, and effects of age and preoperative interval were analyzed.ResultsIn C5‐C6 injuries, 93.1% of nerve transfer patients achieved elbow flexion force ≥M3, which was significantly better when compared to 69.2% of nerve graft patients (p < 0.001). For improved outcomes of nerve transfer patients, shorter preoperative interval was a significant factor in all injury patterns (p < 0.001 for C5‐C6 injuries and total BP injuries, p = 0.018 for C5‐C6‐C7 injuries), and young age was a significant factor in total BP injury pattern (p = 0.022).ConclusionsOur analyses showed that nerve transfers appear superior to nerve graftings especially in patients with a C5‐C6 injury. Unnecessary delays in surgery must be prevented, and younger patients may have more chance for better recovery.Level of evidenceLevel II.

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

Rezende

Veronesi

Paulos

et al. 2020

International Orthopaedics (SICOT)

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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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Reliability of functioning free muscle transfer and vascularized ulnar nerve grafting for elbow flexion in complete brachial plexus palsy

Abstract: IV.

Cited by 23 publications

References 26 publications

Free Gracilis Muscle Transfers Compared with Nonfree Muscle Flaps for Reanimation of Elbow Flexion: A Meta-Analysis

Free Gracilis Muscle Transfers Compared with Nonfree Muscle Flaps for Reanimation of Elbow Flexion: A Meta-Analysis

Elbow flexion reconstruction with nerve transfer or grafting in patients with brachial plexus injuries: A systematic review and comparison study

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

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