Transfer in Patients with Complete Traumatic Brachial Plexus Injury

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 degrees. The wrist extension was restored in 42% of the patients with an average AROM of 20.69 +/- 18.72 degrees. 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: brachial plexus neuropathies, FFMT, free tissue flaps, muscle transfer, traumatic brachial plexus injury, peripheral nerve injuries