Results of functioning free muscle transplantation for elbow flexion

Thirty-eight patients underwent functioning free muscle transplantation for restoration of elbow flexion. Thirty-five patients had sustained brachial plexus injury and 3 had traumatic loss of the biceps muscle. The gracilis muscle was used in 37 patients and the rectus femoris muscle in 4. The transferred muscle was reinnervated by the musculocutaneous (n = 3), intercostal (n = 31), and spinal accessory (n = 4) nerves. Results were assessed by the Medical Research Council grading system and success was defined as a muscle strength of M4. Reinnervation with the musculocutaneous nerve resulted in success in all cases (n = 3) within 1 year. Success was obtained in 78% of patients following transfer of 3 intercostal nerves (n = 23) with recovery in an average of 2 years. Using the spinal accessory nerve (n = 4), strength of only M2+ was achieved, probably on account of the need for interposition nerve grafts in those cases.