Use of functional free muscle transfer for brachial plexus reconstruction after traumatic injury: case report

Abstract

This case report describes the use of functional free muscle transfer (FFMT) with a gracilis muscle graft to reconstruct elbow flexion after a complete traumatic brachial plexus injury. A 31-year-old previously healthy man sustained a complete left brachial plexus injury and a comminuted distal femur fracture in a high-energy motorcycle accident in Belo Horizonte, Brazil, in March 2023. Because the extent of nerve damage ruled out direct nerve repair or grafting, surgeons performed a free gracilis transfer roughly nine months later, reinnervating the muscle via coaptation to the spinal accessory nerve and revascularizing it through anastomoses to the thoracoacromial artery and a cephalic vein tributary. The surgery and postoperative course were uneventful, and the patient entered a structured rehabilitation program. The authors emphasize that detailed knowledge of neurovascular anatomy — guiding donor muscle selection, recipient vessel choice, and nerve coaptation — was essential to the procedure's success, and they conclude that FFMT is a valuable reconstructive strategy for complete brachial plexus injuries when conventional nerve repair is not feasible.