Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 5:14:225-233.
doi: 10.2147/ORR.S367499. eCollection 2022.

The Relationship Between Patient Factors and Clinical Outcomes of Free Functional Muscle Transfer in Patients with Complete Traumatic Brachial Plexus Injury

Heri Suroto  1   2   3 , Indrayuni Lukitra Wardhani  4 , Ratna Darjanti Haryadi  4 , Dina Aprilya  5 , Steven Samijo  6 , Firman Pribadi  1
Affiliations

The Relationship Between Patient Factors and Clinical Outcomes of Free Functional Muscle Transfer in Patients with Complete Traumatic Brachial Plexus Injury

Heri Suroto et al. Orthop Res Rev. .

Abstract

Purpose: Traumatic brachial plexus injury (TBPI) causes severe disabilities to the patients, affecting not only upper limb function but also the psychosocial and economic aspects. Free functional muscle transfer (FFMT) is one of the reconstruction modalities for the management of TBPI. The aim of this study is to evaluate the functional outcomes and their correlation to patient factors.

Patients and methods: This is a retrospective study of 131 patients who suffered from complete TBPI (C5-T1) and were treated with the FFMT procedure to restore elbow flexion and wrist extension from 2010 to 2018 in our institution. We evaluated the active range of motion (AROM), muscle power with MRC (Medical Research Council) scale, DASH score, and complications, with a minimum of 12-month follow-up.

Results: Following FFMT surgery, elbow flexion was significantly and successfully restored (MRC ≥ 3) in 75.5% of patients with an average AROM of 88.17 ± 41.29°. The wrist extension was restored in 42% of the patients with an average AROM of 20.69 ± 18.72°. There was no correlation between age, side of injury, and time to surgery with the functional outcomes. There was a weak correlation between education level, rehabilitation compliance, and elbow functional outcomes.

Conclusion: FFMT is a reliable surgical option to restore elbow flexion in TBPI with a high satisfactory result. Our findings suggested that the FFMT indication is potentially expanded regardless of the patient factors.

Keywords: FFMT; brachial plexus neuropathies; free tissue flaps; muscle transfer; peripheral nerve injuries; traumatic brachial plexus injury.

PubMed Disclaimer

Conflict of interest statement

The authors declare no potential conflict of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Free functional muscle transfer (FFMT) surgical technique illustration. The origin of the transferred gracilis muscle was implanted directly to the periosteum middle-third clavicle with continuous suture through proximal tendon part of gracilis muscle. The distal tendon was placed underneath the lacertus fibrosus and mobile wad compartment, and then attached to the proximal side of the Extensor Carpi Radialis Brevis (ECRB) tendon. Green coloured: Gracilis muscle.
See this image and copyright information in PMC

References

    1. Bhandari PS, Bhatoe HS, Mukherjee MK, Deb P. Management strategy in post traumatic brachial plexus injuries. Indian J Neurotrauma. 2012;9(1):19–29. doi:10.1016/j.ijnt.2012.04.010 - DOI
    1. Yang Y, Yang JT, Fu G, et al. Functioning free gracilis transfer to reconstruct elbow flexion and quality of life in global brachial plexus injured patients. Sci Rep. 2016;6(February):1–10. doi:10.1038/srep22479 - DOI - PMC - PubMed
    1. Yi Lee TM, Sechachalam S, Satkunanantham M. Systematic review on outcome of free functioning muscle transfers for elbow flexion in brachial plexus injuries. J Hand Surg Eur Vol. 2019;44(6):620–627. doi:10.1177/1753193419825527 - DOI - PubMed
    1. Fischer JP, Elliott RM, Kozin SH, Levin LS. Free function muscle transfers for upper extremity reconstruction: a review of indications, techniques, and outcomes. J Hand Surg Am. 2013;38(12):2485–2490. doi:10.1016/j.jhsa.2013.03.041 - DOI - PubMed
    1. Suroto H, Antoni I, Siyo A, et al. Traumatic Brachial Plexus Injury in Indonesia: an experience from a developing country. J Reconstr Microsurg. 2021. doi:10.1055/s-0041-1735507 - DOI - PMC - PubMed