DOUBLE FREE-MUSCLE TRANSFER TO RESTORE PREHENSION FOLLOWING COMPLETE BRACHIAL-PLEXUS AVULSION

Restoration of finger flexion and extension as well as elbow flexion a nd extension with a double free-muscle and multiple nerve transfers fo llowing complete avulsion of the brachial plexus (nerve roots C5 to T1 ) is reported. The procedure combines (1) free-muscle transfer with re innervation by the spinal accessory nerve to achieve elbow flexion and finger extension, (2) free-muscle transfer with reinnervation by the fifth and sixth intercostal nerves to restore finger flexion, (3) thir d and fourth intercostal motor nerve transfer to the triceps brachi to extend and stabilize the elbow, (4) nerve transfer of the supraclavic ular nerve or nerve transfer of the sensory rami of the intercostal ne rves to the median nerve to restore hand sensibility, and (5) glenohum eral arthrodesis. Seven of 10 patients recovered elbow function and fi nger flexion and extension. Five patients reported use of their hand i n activities of daily living.