Functional Free Muscle Transfer Reconstruct Upper Extremity Function

Objectives:Follow-up the curative effect of upper extremity function reconstruction by functional free muscle transplant and compare muscle strength of free gracilis muscle transplantation on upper extremity reconstruction with latissimus dorsi free transplantation. Then explore the advantages of free gracilis muscle transplantation and provide reliable basis for the clinical application of the operation.Methods:From Jan.2007 to Dec.2014, a total of 65 patients admitted to our department were performed functional free muscle transplantation to restore elbow flexion, elbow extension and (or) finger flexion/extension, Among them, 62 were suffer from brachial plexus injury and 3 were muscle defects in upper extremity. According to the types of functional free muscle they were divided into two groups:gracilis muscle group included 52 cases and latissimus dorsi group included 13 cases. In gracilis muscle group, after surgery transferred muscle necrosis completely occurred in four cases, muscle flap survival but skin flap necrosis occurred in two cases. In latissimus dorsi group, flap necrosis in 3 cases. A total of 36 cases were fallowed up for more than 6 months, including 26 cases in gracilis muscle group and 10 cases in latissimus dorsi group(all fallowed up for more than 4 years). Recording the postoperative strength of transferred muscle, and the recovery of elbow flexion, elbow extension and (or) finger flexion/extension. The functional recovery of limbs was assessed according to Peripheral nerve function evaluation standard setting up by hand surgery branch of Chinese Medical Association and Medical Research Council (MRC). All date were statistics analysis by using SPSS for Windows 16.0 software. The comparison of two independent ranked datas was used Wilcoxon rank sum test, and all significance tests of the standard test were bilateral p< 0.05.Results:(1) 36 cases were followed up for more than 6 months. The average followe up time of gracilis muscle group was 38.8±24.7 months and of latissimus dorsi group was 62.5±12.9 months.(2) the time of transferred muscle postoperative first contraction in gracilis muscle group and latissimus dorsi group were [(5.3±1.2)月, X±S] and [(7.7±1.7)月, X±S], respectively. (3) In gracilis muscle group, postoperative muscle force recovered were M0-2 grades in 6 cases, M3 grades in 10 cases, M4 grades in 9 cases, M5 grades in 1 case. In latissimus dorsi group, postoperative muscle force recovered were M0-2 grades in 6 cases, M3 grades in 3 cases, M4 grades in 1case, M4 grades in 0 cases. The difference of postoperative transferred muscle force between the two groups was statistically significant (P<0.05).Conclusions:(1) Functional free muscle transplant is a reliable method for upper extremity function reconstruction. (2) Free gracilis muscle transplantation is more adaptable to upper extremity reconstruction than free latissimus dorsi muscle transplantation. Free gracilis muscle transplantation should be considered to be the first choice when functional free muscle transfer reconstruct upper extremity is performed.