Mehmet Armangil1, Seyyid Şerif Ünsal2, Tuğrul Yıldırım3, Uğur Bezirgan4, Anar Keremov1, Sinan Adıyaman1, Sırrı Sinan Bilgin1

1Department of Orthopedics and Traumatology, Ankara University, Faculty of Medicine, Ankara, Turkey
2Department of Hand Surgery, Kanuni Training and Research Hospital, Trabzon, Turkey
3Department of Orthopedics and Traumatology, Hand and Microsurgery & Orthopedics and Traumatology Hospital, Izmir, Turkey
4Department of Hand Surgery, Ankara City Hospital, Ankara, Turkey

Keywords: Brachial plexus paralysis, elbow flexion, free muscle transfer, neurotization.


Objectives: The aim of this study was to evaluate the functional outcomes of patients with free gracilis muscle transfer (FGMT) for the restoration of elbow flexion.

Patients and methods: Between January 2012 and January 2019, a total of 16 patients (13 males, 3 females; mean age: 27.3±11.7 years; range: 18 to 53 years) who underwent FGMF to achieve elbow flexion after traumatic brachial plexus palsy (TBPP) were retrospectively analyzed. Data including demographic and clinical characteristics of the patients, etiology, affected side, injury level, accompanying injuries, time between injury and surgery, follow-up time, complications, whether nerve reconstruction and artery repair were performed previously, and details of the procedure were recorded. The outcome measures were elbow range of motion in degrees, muscle strength, and Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-36 (SF-36) scores.

Results: The mean follow-up was 30±11.5 (range, 24 to 42) months. Two patients had C5-C8 injuries, two patients had C6-T1 injuries, and all other patients had injuries to the C5-T1 roots. Muscle strength was M3/M4 in 11 (68.8%) patients, M2 in two (12.5%) patients, and M0 in one (6.2%) patient. The median active range of motion of the elbow joint in patients with successful results (M3 and above) was measured as 75 (range, 30 to 100) degrees. A statistically significant improvement was observed in the pre- and postoperative DASH scores and in some SF-36 subscale scores of patients with successful results.

Conclusion: Free gracilis muscle flap is a reliable option in the restoration of elbow flexion in patients with TBPP. Although there is an improvement in functional results, disability, and quality of life, there may be no change in patients’ mental status and pain.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.