|89th Annual Meeting Abstracts
Free Muscle Transfer In Posttraumatic Plexopathies Part II: The Elbow
Julia K. Terzis, MD, PhD, Vasileios Kostopoulos, MD.
Eastern Virginia Medical School, Norfolk, VA, USA.
Purpose: The indications for free muscle transfer in brachial plexopathies are prolonged denervation time or inadequate upper extremity function after primary nerve reconstruction. The purpose of this study is to analyse the outcomes of free muscle transfer for elbow flexion and extension in brachial plexopathies in relation to the different muscles used, and the respective motor donors.
Materials and Methods: Seventy three muscles were transferred for elbow flexion, and ten for elbow extension. Latissimus dorsi (LD) was used in thirty-seven cases, gracilis in twenty-eight, rectus femoris(RF)in seven and vastus lateralis in one. Five latissimus dorsi and five gracilis were transferred for elbow extension.
Results: Patients younger than 15 years yielded better results than older patients for elbow flexion. When LD was transferred the mean muscle grading (MG) was 3.33±0.25 when the neurotization was
from intercostals; these outcomes were statistically significant when compared with outcomes of free gracilis transfer (MG 2.25±0.6). There was also statistically significant difference when free LD was neurotized with three intercostals as compared with two intercostals nerves. RF yielded also good results when neurotized from contralateral C7 (cC7) (MG 3.67±0.6. For elbow extension the better
outcomes of LD were not statistically significant.
Conclusion: Among all the free muscle transfers for upper extremity reconstruction, elbow reanimation yielded the most rewarding outcomes. The selection of powerful muscle units was more important than the effect of neurotization which was not as strong as it was in muscle transfers for facial or hand reanimation.