Restoration of elbow flexion and wrist extension in brachial plexus paralyses by means of free muscle transplantation innervated by intercostal nerve.

Traumatic lesions of the brachial plexus with nerve root avulsion pose extremely complex therapeutic problems. Since 1965, the authors have performed neurotization of the musculocutaneous nerve by intercostal nerves in order to restore elbow flexion. The results of this operation are considerably poorer when the interval between the trauma and the neurotization exceeds 6 months. In these late cases, the authors have used, since 1978, a free muscle transfer reinnervated by a transposed intercostal nerve. 17 patients have been operated by means of this technique; 8 of the 11 patients with a follow-up exceeding one year recovered elbow flexion force evaluated to be M3 or more. Encouraged by these results, the authors have extended this procedure to restoration of wrist extension by free musculocutaneous transfer of the gracilis muscle innervated by intercostal nerves. 17 of the 29 patients operated have a follow-up of more than one year and 9 these cases have regained wrist extension with a score of M3 or more.