Electromyographic Findings in Gracilis Muscle Grafts Used to Augment Elbow Flexion in Traumatic Brachial Plexopathy

BACKGROUND:: Gracilis muscle graft transplantation is one of the last resort surgical options to restore elbow flexion in patients with chronic traumatic upper trunk brachial plexopathies. METHODS:: We retrospectively identified 34 patients who underwent surgeries between 1997 and 2014, and had postoperative follow-up for at least 12 months. Demographic, clinical and electromyographic pre and postoperative data were analyzed. RESULTS:: The median age of injury was 30 years old. Most subjects had complete loss of elbow flexion preoperatively (n=28, 82.4%). Median time from injury to surgery was 20 months (range = 3-226 months). It did not correlate with the time to reinnervation on EMG (r = 0.35, 95% CI = 0.007-0.62) or with the time improvement in muscle strength (r= 0.35, 95% CI= 0.007-0.62). The mean postoperative follow up interval was 22.35 months. During that period, 32 out of 34 (94%) patients achieved reinnervation. Median times from surgery to graft innervation and to any improvement in elbow flexor muscle power were the same (8.5 months) with overlapping time to event curves. CONCLUSION:: Despite the long standing and complete loss of elbow flexion in the majority of our patients, gracilis transfer surgeries has helped most of them to achieve reinnervation and start to regain function. Electromyography is a helpful tool that along with the clinical examination can predict postoperative improvement.