Author/Authors :
Atthakomol, Pichitchai Research performed at the Hand and Upper Extremity Service - Department of Orthopaedic Surgery - Massachusetts General Hospital - Harvard Medical School, Boston, Massachusetts, USA , Ozkan, Sezai Research performed at the Hand and Upper Extremity Service - Department of Orthopaedic Surgery - Massachusetts General Hospital - Harvard Medical School, Boston, Massachusetts, USA , Eberlin, Kyle R Research performed at the Hand and Upper Extremity Service - Department of Orthopaedic Surgery - Massachusetts General Hospital - Harvard Medical School, Boston, Massachusetts, USA , Chen, Neal Research performed at the Hand and Upper Extremity Service - Department of Orthopaedic Surgery - Massachusetts General Hospital - Harvard Medical School, Boston, Massachusetts, USA , Winograd, Jonathan Research performed at the Hand and Upper Extremity Service - Department of Orthopaedic Surgery - Massachusetts General Hospital - Harvard Medical School, Boston, Massachusetts, USA , Lee, Sang-Gil Research performed at the Hand and Upper Extremity Service - Department of Orthopaedic Surgery - Massachusetts General Hospital - Harvard Medical School, Boston, Massachusetts, USA
Abstract :
Background: Free functional gracilis muscle transfers (FFGT) are an option for reconstruction after traumatic brachial
plexus injury. Few studies report the rate of revision surgeries following free functional muscle transfers. We examined
the reoperation rate and indication for reoperation after primary reconstruction of upper extremity function with a free
gracilis transfer after brachial plexus injury.
Methods: From 2003-2016, we identified 25 patients who underwent a free functional gracilis muscle transfer for
restoration of upper extremity function. We reviewed their medical charts to record patient, injury, and treatment
characteristics. Indication for reoperation and reoperative procedure were also identified.
Results: Fourteen out of 25 patients (56%) had a reoperation after FFGT. Four flaps were re-explored for vascular
compromise, but there were no flap failures. The majority of reoperations involved adjustment of tendon excursion
(8/14) which demonstrated that tenolysis was the main procedure.
Conclusion: Despite promising results of free functional gracilis transfers, reoperation is relatively common and should
be discussed with the patient as a preoperative strategy. Early exploration of vascular compromise may decrease the
flap failure. Poor tendon excursion is a common unpredicted consequence after FFMT and is the main indication for
reoperation.
Keywords :
Reoperation rate , Indication , Free functional muscle transfers , Brachial plexus injury
