Complications and outcomes of functional free gracilis transfer in brachial plexus palsy

The purpose of this study was to evaluate the outcomes and complications following free functional gracilis transfer for restoration of elbow flexion and/or finger flexion in patients with acute or chronic brachial plexus injuries. A review of 130 free functioning gracilis muscles transferred for brachial plexus injuries was undertaken to evaluate the failure rate as well as late complications. The overall failure rate (defined as a non-function muscle or one that failed acutely) was 15.4%. The most common late complication was fracture of the clavicle (5.4%). A technical modification of the procedure resulted in a decrease in these complications from a early rate of 7.9% graft failures and 7.9% clavicle fractures to a 2.4% (n = 1) failure rate and zero clavicle fractures in the subsequent 41 consecutive cases. Observations made in this series lead to a technique change, which has thus far resulted in no clavicle fractures, no bowstringing, improved graft viability and function, and a statistically significant decrease in overall complications (p < 0.001) associated with use of functioning free gracilis transfer in brachial plexus reconstruction.