Background
In total brachial plexus injuries, the paucity of donor nerves run contradictory to the overwhelming number of paralyzed functions that need reconstruction. Functional hand reconstruction is often neglected for the sake of preserving donor nerves for other functions. Here we describe the use of a gracilis FFMT neurotized by branches of previously re-innervated median nerve for finger flexion, in total plexus patients who had received vascularized ulnar nerve graft reconstruction. The aim of this study is to report the functional outcomes of this surgical strategy.
Materials and Methods
Between 1998 and 2015, a total of 35 patients received FFMT for finger flexion, using previously reinnervated median nerve branches as the source of neurotization. The muscle power finger flexion (M), the satisfactory rate (≥M2), and the active range of motion of finger flexion were recorded. Also, the patient-reported outcomes, including the quick DASH and the Michigan Hand Outcomes Questionnaire (MHQ) were obtained.
Results
The average finger flexion reached M 1.50±0.68, which showed statistical significance compared to the pre-operative muscle power, M 0.87±0.56 (p=0.026). And 25.71% of the patients had a muscle power greater than M2. The average postoperative Quick DASH score was 47.7. The overall MHQ score was 46.9.
Conclusion
FFMT neurotized by previously innervated median nerve branches are able to augment finger flexion and improve quality of life. The surgical strategy provides efficient use of common donor nerves while recycling previously innervated motor branches for better long-term outcome.

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