Outcome of Surgical Reconstruction After Traumatic Total Brachial Plexus Palsy

Background: Double free muscle transfer for the treatment of traumatic total brachial plexus injury provides useful prehensile function. We studied the outcome of this muscle transfer procedure, including the changes in disability and quality-of-life scores. Methods: Thirty-six patients with traumatic total brachial plexus injury who underwent double free muscle transfer for reconstruction from 2002 to 2008 and had a minimum follow-up of twenty-four months after the second free muscle transfer were studied. All were evaluated preoperatively and postoperatively with use of the Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-36 (SF-36) questionnaires. A separate questionnaire was used to determine job status, pain, use of the reconstructed hand, and satisfaction with the procedure. Results: The mean patient age was twenty-nine years (range, sixteen to forty-nine years), and the mean duration of follow-up was thirty-six months (range, twenty-four to seventy-nine months). The mean active range of motion was 23 degrees (range, 0 degrees to 80 degrees) for shoulder flexion, 31 degrees (range, 0 degrees to 90 degrees) for shoulder abduction, -18 degrees (range, -80 degrees to 40 degrees) for shoulder external rotation, 62 degrees (range, 0 degrees to 130 degrees) for the shoulder rotation arc, 119 degrees (range, 90 degrees to 150 degrees) for elbow flexion, and -33 degrees (range, -60 degrees to -20 degrees) for elbow extension. The power of elbow flexion was M4 in twenty-five patients and M3 in eleven. Twenty-three patients had triceps nerve reconstruction; extension was MO in two of these patients, M1 in seven, M2 in ten, and M3 in four. Total active motion of the fingers was 46 degrees (range, 0 degrees to 98 degrees), with a mean hook grip strength of 4 kg (range, 0 to 12 kg). Wilcoxon tests revealed significant improvements in the DASH score and the SF-36 physical functioning, role physical, and physical component summary scores. The majority of patients worked but had changed their type of work, used the reconstructed hand in activities of daily living that required both hands, and were satisfied with the procedure. Conclusions: Double free muscle transfer yielded satisfactory function and allowed use of the reconstructed hand in activities that required both hands. The improvement in the DASH score was greater than that in the SF-36 score.