In lower brachial plexus avulsion injuries, hand reanimation with free muscle transfer is a challenging procedure. This article analyzes the senior author’s extensive experience in the field.
Since 1981, seventy-one free gracilis muscles were transferred for finger flexion and extension. The transferred muscle was neurotized to intercostal nerves, contralateral C-7 root, spinal accessory nerve, or the upper roots of the ipsilateral plexus. The results indicate that the strongest motor donor for finger extension is the spinal accessory nerve. The intercostal nerves were useful for finger flexion and the contralateral C-7 root was useful for finger extension. The authors conclude that reanimation of the hand by means of free muscle transfer is a worthwhile endeavor with modest outcomes.
In severe plexopathy patients with multiple root avulsions, the prevailing attitude has been to stabilize the shoulder and provide elbow flexion. However, finger flexion and extension are compromised and often overlooked. This article presents the senior authors 26-year experience in hand reanimation by means of functional free muscle transfer. The outcomes achieved are modest particularly in light of the great surgical effort required. However, for the compliant patient with supple finger joints, these procedures may transform the paralyzed limb to become a useful assist extremity.