Abstract
OBJECTIVE:To investigate the feasibility of using free gracilis muscle transfer along with the brachialis muscle branch of the musculocutaneous nerve to restore finger and thumb flexion in lower trunk brachial plexus injury according to an anatomical study and a case report.METHODS:Thirty formalin-fixed upper extremities from 15 adult cadavers were used in this study. The distance from the point at which the brachialis muscle branch of the musculocutaneous nerve originates to the midpoint of the humeral condylar was measured, as well as the length, diameter, course and branch type of the brachialis muscle branch of the musculocutaneous nerve. An 18-year-old male who sustained an injury to the left brachial plexus underwent free gracilis transfer using the brachialis muscle branch of the musculocutaneous nerve as the donor nerve to restore finger and thumb flexion. Elbow flexion power and hand grip strength were recorded according to British Medical Research Council standards. Postoperative measures of the total active motion of the fingers were obtained monthly.RESULTS:The mean length and diameter of the brachialis muscle branch of the musculocutaneous nerve were 52.66±6.45 and 1.39±0.09 mm, respectively, and three branching types were observed. For the patient, the first gracilis contraction occurred during the 4th month. A noticeable improvement was observed in digit flexion one year later; the muscle power was M4, and the total active motion of the fingers was 209°.CONCLUSIONS:Repairing injury to the lower trunk of the brachial plexus by transferring the brachialis muscle branch of the musculocutaneous nerve to the anterior branch of the obturator nerve using a tension-free direct suture is technically feasible, and the clinical outcome was satisfactory in a single surgical patient.
Highlights
Traumatic brachial plexus injuries (BPI) are among the most severe peripheral nerve injuries in clinical practice and can cause permanent disability of the upper extremities [1]
The contralateral C7 (CC7) nerve and the intercostal nerve are mainly used as donor nerves to restore hand function when transferring the gracilis muscle [12]
One surgeon successfully reconstructed the function of digit flexion by transferring the brachialis muscle branch of the musculocutaneous nerve (BMBMCN) to the posterior part of the median nerve in patients
Summary
Traumatic brachial plexus injuries (BPI) are among the most severe peripheral nerve injuries in clinical practice and can cause permanent disability of the upper extremities [1]. Among these treatments, nerve transfer and tendon transfer are two common approaches [4,5,6,7]. Free gracilis muscle transfer can be used to restore elbow and finger function after devastating BPIs [8,9,10,11]. The contralateral C7 (CC7) nerve and the intercostal nerve are mainly used as donor nerves to restore hand function when transferring the gracilis muscle [12]. Due to the limited availability of usable donor nerves and unsatisfactory results, restoration of sufficient hand function following injury to the inferior trunk of the brachial plexus is still challenging. One surgeon successfully reconstructed the function of digit flexion by transferring the brachialis muscle branch of the musculocutaneous nerve (BMBMCN) to the posterior part of the median nerve in patients
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