Doi describes his staged technique of double free gracilis muscle transfer for prehensile reconstruction following total paralysis of the brachial plexus. He then reviews 44 patients who underwent the specific reconstructive steps, involving nerve repair and muscle and nerve transfers. At a mean follow-up interval of 40 months, variable degrees of active shoulder, elbow, and finger motion were achieved. Most patients obtained protective sensation in the hand. Doi emphasizes the importance of a highly motivated patient, proximal joint stability, and prolonged rehabilitation for success of the technique.
Similar double free-muscle techniques have been reported in the literature (Shin et al., JAAOS 2005). The procedures are complex and the results are imperfect. Nevertheless, the functional gains achieved in a highly motivated patient may have a positive impact on his/her quality of life with the ability to perform two-handed activities (e.g., holding a bottle while opening the cap).