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Introducción: La neuroestimulación intraoperatoria constituye una técnica esencial durante la cirugía del plexo braquial, pues permite la identificación específica de las estructuras neurales. En determinadas circunstancias, la intensidad precisa de la estimulación nerviosa y la respuesta motora evocada, las cuales son fundamentales para la toma de decisiones críticas durante el acto quirúrgico. Objetivo: Describir la utilización de un neuroestimulador de anestesia regional para la localización neural intraoperatoria durante la cirugía del plexo braquial en dos pacientes. Presentación de casos: Caso 1: paciente con diagnóstico de lesión del fascículo lateral del plexo braquial derecho y lesión alta del nervio radial homolateral. La estimulación neural, con estímulos graduales y progresivos, permite la diferenciación adecuada de los nervios mediano, cubital, musculocutáneo y cutáneo braquial lateral, el fascículo motor del nervio cubital que inerva el músculo cubital anterior, y el fascículo motor del nervio musculocutáneo que inerva el bíceps, lo que posibilita la neurotización entre ambos fascículos. Caso 2: paciente con diagnóstico de lesión total del plexo braquial izquierdo, posganglionar. Luego de la exploración y neurólisis, se identificó el tronco superior, se efectuó la estimulación eléctrica gradual, lo que requirió una elevada intensidad, y se registó, únicamente, como respuesta motora evocada la contracción débil del músculo pectoral mayor ipsilateral. Conclusiones: La utilización de un neuroestimulador de anestesia regional para la localización neural durante la cirugía del plexo braquial, presenta ventajas prácticas relevantes en relación con los neuroestimuladores desechables, así como una relación costo-beneficio apropiada para su implementación en entornos y naciones de recursos limitados(AU)
Introduction: Intraoperative neurostimulation is an essential technique during brachial plexus surgery, as it allows the specific identification of neural structures. In certain circumstances, the precise intensity of nerve stimulation and the evoked motor response are fundamental for making critical decisions during the surgical act. Objective: Describe the use of a neurostimulator of regional anaesthesia for intraoperative neural localization during brachial plexus surgery in two patients. Case presentation: Case 1: patient diagnosed with lesion of the lateral fasciculus of the right brachial plexus and high lesion of the homolateral radial nerve. Neural stimulation, with gradual and progressive stimuli, allows the adequate differentiation of the median, ulnar, musculocutaneous and lateral brachial cutaneous nerves, the motor fasciculus of the ulnar nerve that innervates the anterior ulnar muscle, and the motor fasciculus of the musculocutaneous nerve that innervates the biceps, which enables neurotization between both fascicles. Case 2: patient diagnosed with total lesion of the left brachial plexus, postganglionic. After the exploration and neurolysis, the upper trunk was identified, the gradual electrical stimulation was carried out, which required a high intensity, and the weak contraction of the ipsilateral pectoralis major muscle was recorded only as an evoked motor response. Conclusions: The use of a neurostimulator of regional anesthesia for neural localization during brachial plexus surgery presents relevant practical advantages in relation to disposable neurostimulators, as well as an appropriate cost-benefit ratio for their implementation in environments and nations of limited resources(AU)
Subject(s)
Humans , Male , Female , Brachial Plexus/surgery , Electric Stimulation TherapyABSTRACT
@#Reconstruction of chronic boutonniere deformity remains to be a challenging procedure especially when combined with other debilitating injuries in the same extremity. The balance to properly tension the reconstruction with active motion is often prevented by the need to perform the procedure under sedation of block to tolerate the use of tourniquet. We present a case of a young patient who successfully underwent restoration of active proximal interphalangeal (PIP) extension with a Palmaris longus graft while wide awake under local anesthesia and no tourniquet (WALANT) before subsequently having nerve transfers for upper type brachial plexus injury.
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INTRODUCTION@#Brachial plexus injuries (BPI) have devastating functional effects. Clinical outcomes of BPI reconstruction have been documented in literature; however, these do not use EMG and quantitative kinematic studies.@*OBJECTIVE@#This study aims to use a markerless motion analysis tool (KINECT) and surface EMG to assess the functional outcomes of adult patients with traumatic upper trunk BPI who have undergone nerve transfers for the shoulder and elbow in comparison to the normal contralateral limb.@*METHODS@#This is an exploratory study which evaluated three participants with BPI after nerve reconstruction. KINECT was used to evaluate the kinematics (range of motion, velocity, and acceleration) and the surface EMG for muscle electrical signals (root mean square, peak EMG signal, and peak activation time) of the extremities. The means of each parameter were computed and compared using t-test or Mann-Whitney U test.@*RESULTS@#Participant C, with the best clinical recovery, showed mostly higher KINECT and EMG values for the BPI extremity. There was a significant difference between the KINECT data of Participants A and B, with lower mean values for the BPI extremity. Most of the EMG results showed lower signals for the BPI extremity, with statistical significance.@*CONCLUSION@#The KINECT and surface EMG provide simple, cost-effective, quick, and objective assessment tools. These can be used for monitoring and as basis for formulating individualized interventions. A specific algorithm should be developed for the KINECT sensors to address errors in data collection. A fine needle EMG may be more useful in evaluating the muscles involved in shoulder external rotation.
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Our previous investigation suggested that faster seventh cervical nerve (C7) regeneration occurs in patients with cerebral injury undergoing contralateral C7 transfer. This finding needed further verification, and the mechanism remained largely unknown. Here, Tinel's test revealed faster C7 regeneration in patients with cerebral injury, which was further confirmed in mice by electrophysiological recordings and histological analysis. Furthermore, we identified an altered systemic inflammatory response that led to the transformation of macrophage polarization as a mechanism underlying the increased nerve regeneration in patients with cerebral injury. In mice, we showed that, as a contributing factor, serum amyloid protein A1 (SAA1) promoted C7 regeneration and interfered with macrophage polarization in vivo. Our results indicate that altered inflammation promotes the regenerative capacity of the C7 nerve by altering macrophage behavior. SAA1 may be a therapeutic target to improve the recovery of injured peripheral nerves.
Subject(s)
Animals , Humans , Mice , Brachial Plexus , Brachial Plexus Neuropathies/surgery , Nerve Transfer , Peripheral Nerves , Spinal NervesABSTRACT
Our previous investigation suggested that faster seventh cervical nerve (C7) regeneration occurs in patients with cerebral injury undergoing contralateral C7 transfer. This finding needed further verification, and the mechanism remained largely unknown. Here, Tinel’s test revealed faster C7 regeneration in patients with cerebral injury, which was further confirmed in mice by electrophysiological recordings and histological analysis. Furthermore, we identified an altered systemic inflammatory response that led to the transformation of macrophage polarization as a mechanism underlying the increased nerve regeneration in patients with cerebral injury. In mice, we showed that, as a contributing factor, serum amyloid protein A1 (SAA1) promoted C7 regeneration and interfered with macrophage polarization in vivo. Our results indicate that altered inflammation promotes the regenerative capacity of the C7 nerve by altering macrophage behavior. SAA1 may be a therapeutic target to improve the recovery of injured peripheral nerves.
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The brachial plexus injury is a rare condition that is commonly categorized as traumatic or obstetric injuries. The brachial plexus injuries commonly occurred due to motor vehicle accidents. This plexus is created problem with a lack of sensory and motor dysfunction, neurologic degeneration, atrophy of related muscle groups. The physiotherapist is aware effectively to create a plan of care for the betterment of patient’s condition. The case study was used to highlight the effectiveness of physiotherapy for traumatic brachial plexus injury. 3.6 years old girl was diagnosed as left brachial plexus injury. The child is receiving physiotherapy treatment from November 2018 to till now, 3 times in a week. The treatment focused on improving active movement, muscle power, sensation, weight bearing and unimanual and bimanual function. This child’s clinical status is improving day by day including: ROM, muscle strength, improved symmetrical weight bearing, unimanual and bimanual function. The outcome measures were goniometer, Oxford muscle grading scale and Nrakas Sensory Grading System for sensory assessment. The shoulder active movement especially flexion, abduction and external rotation, elbow flexion was increases. The muscle power of shoulder flexor, abductor, external rotator and elbow flexor were also improved but the sensation of elbow area is only improved. The sensation of shoulder area was not changed. This case studies highlighted that physiotherapy is effective to improve ROM, muscle power, weightbearing as well as function (one hand and both hand) for traumatic brachial plexus injury.
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Objectives: The study aimed to find if the balance was impaired in patients of traumatic brachial plexus injury. The objectives were to assess the static balance using single leg stance test time and dynamic balance using the time component of modified dynamic gait index in adults with partial or complete brachial plexus injury (study group) and compare it with healthy normal adults (control group). Methodology: It was a cross-sectional, comparative, observational, single-center study carried out for a period of 6 months including statistical analysis. Total 20 patients with partial or complete traumatic brachial plexus injury and 20 age and gender-matched healthy normal adults were recruited from 18-45 years of age, of either gender who were willing to participate in the study. Individuals with any congenital, cognitive, vascular, neurological issues or with injuries to lower limb were excluded. Static balance was measured using single leg stance test time (in seconds) thrice for each leg (its average was then taken) and the dynamic balance was measured using the score out of 24 for time variable of modified dynamic gait index. Results: No statistical difference in left (p=0.3141) or right (p=0.1572) single leg stance test time was observed, however, there was a statistical difference in ‘time’ component of modified dynamic gait index between the 2 groups (p<0.001). Conclusion: The study shows that the static balance was not affected but the dynamic balance was affected in patients with traumatic brachial plexus injury.
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Lying on the side while falling asleep deeply after drinking or taking a sleeping pill can cause compressive neuropathy. We report a 70-year-old male patient of medial cord of left brachial plexus injury (BPI) after deep sleep. The mechanism of the injury might be compression and stretching of brachial plexus. The electrodiagnostic study was performed and the medial cord lesion of BPI was suggested. The ultrasonography image of compression site revealed the nerve swelling of medial cord of brachial plexus and median nerve at the mid-arm level. Pharmacologic treatment including oral prednisolone and exercise training were prescribed. On 6 months after initial visit, neurologic symptom and pain were improved but mild sequelae was remained.
Subject(s)
Aged , Humans , Male , Accidental Falls , Brachial Plexus , Deception , Drinking , Electrodiagnosis , Median Nerve , Neurologic Manifestations , Prednisolone , UltrasonographyABSTRACT
Introdução: Dentre as Lesões do Plexo Braquial (LPB), 80% a 90% são resultantes de traumas auto/motociclísticos. As Lesões Traumáticas do Plexo Braquial (LTPB) são uma condição altamente incapacitante, com prevalência em homens entre 21 e 40 anos, que em sua maioria, são moradores de região urbana e trabalhadores braçais. Objetivo: O estudo visa realizar uma das três etapas necessárias para a validação de um instrumento de avaliação da funcionalidade, baseado na Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), para indivíduos com LTPB. Métodos: Trata-se de um estudo qualitativo com grupo focal, composto por 5 (cinco) indivíduos adultos com LTPB. Resultados: Das cinquenta e seis categorias da CIF presentes no instrumento a ser validado, trinta e uma foram relatadas pelos indivíduos que participaram do grupo focal. Uma categoria referente ao componente de atividade e participação foi citada pelos participantes e não havia sido contemplada pelo instrumento. Em relação às categorias da CIF de fatores ambientais, apenas duas categorias citadas pelos participantes do grupo não estão presentes no instrumento de avaliação. Conclusão: A maioria das categorias da CIF presentes no instrumento de avaliação a ser validado pôde ser confirmada a partir da perspectiva de indivíduos com LTPB participantes do grupo focal. (AU)
Among brachial plexus injuries (BPI), 80% to 90% are result of automovel or motorcycle traumas. Traumatic brachial plexus injuries (TBPI) are a highly incapacitating condition. The most prevalent are in men between the ages of 21 and 40, where the majority are urban residents and manual workers. Objective: The aim of this study is the validation of a functional evaluation tool based on International Classification of Functioning, Disability and Health (ICF) for individuals with TBPI. Methodology: This is a qualitative study with a focal group, composed of 5 (five) adult individuals with TBPI. Results: Of the fifty-six ICF categories present in the instrument to be validated, thirty-one were reported by individuals who participated in focal group. Only one category referring to the activity and participation component was mentioned by the participants and had not been contemplated by the instrument. Regarding the ICF categories of environmental factors, only two categories cited by group participants are not present in the assessment. Conclusion: Most of the ICF categories present in the assessment instrument to be validated could be confirmed from the perspective of individuals with TBPI participants in the focus group. (AU)
Subject(s)
Humans , Male , Adult , Young Adult , Brachial Plexus/injuries , Activities of Daily Living/psychology , Accidents, Traffic/statistics & numerical data , Brachial Plexus Neuropathies/diagnosis , Disability Evaluation , International Classification of Functioning, Disability and Health , Focus Groups/methods , Qualitative Research , Validation Studies as TopicABSTRACT
Radiotherapy is an important part of the postoperative adjuvant therapy of breast cancer. Radiation-induced brachial plexopathy (RIBP) of postoperative radiotherapy severely reduces the quality of life of breast cancer patients. In this article, the general situation, mechanism, diagnosis, risk factors, treatment and preventive measures of RIBP were reviewed.
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Objective To evaluate the value of MRI in diagnosis of brachial plexus injury in infants.Methods MRI manifestations and electromyography(EMG) data of 14 cases were analyzed retrospectively.Kappa statistic was used to analyze the consistency between the two methods.Results Pure preganglionic injuries were found in 5 cases,preganglionic and postganglionic combined injuries occurred in 9 cases.MRI features of preganglionic injuries include:absence of roots in spinal canal (7 cases),nerve root enlargement (1 case),nerve sleeve dilation (3 cases),pseudomeningoceles (5 cases) and the dura thickening (3 cases).MRI features of postganglionic injuries include:trunk thickening with hyperintensity in STIR images(14 cases),adjacent structure disorder and edema (1 cases).The consistency of MRI and EMG was good (κ=0.752,P＜0.05).Conclusion MRI is an efficient method for demonstrating preganglionic and postganglionic injuries,and can provide reliable information for early diagnosis and treatment for brachial plexus injury in infants.
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Objective To evaluate the clinical value of enhanced 3D-SPACE-STIR sequence MR in brachial plexus injury post-ganglionic nerve.Methods Eighteen patients with suspected brachial plexus injury were examined by routine MRI,3D-SPACE-STIR sequence and enhanced scan.The position,morphology,signal intensity of the brachial plexus injury and its relation with the proximal and distal portions of the brachial plexus were evaluated by senior radiologists.The image quality of plain and enhanced 3D-SPACE-STIR was evaluated respectively.Results The CNR of plain scan and enhanced 3D-SPACE-STIR sequence images were 32.31+2.98 and 43.66+2.78 respectively and the difference was statistically significant.Plain and enhanced 3D-SPACE-STIR sequences of supraclavicular nerves display rate were 95.0% and 96.1% respectively without having statistically significant difference.However,the subclavicular segment of the brachial plexus showed the displaying rates of 66.7% and 94.4% and the difference was statistically significant.Moreover, the background suppression effect of enhanced scan was better than that of the plain scan.Conclusion Enhanced 3D-SPACE-STIR sequence can clearly show brachial plexus injury,and its image quality is better than that of the plain scan,which can provide important imaging basis for accurate diagnosis of brachial plexus injury.
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Objective To study the effects of Puerarin(Pue)on survival rate,expression of GAP-43 and NGF in spinal motoneurons following brachial roots avulsion. Methods From March, 2014 to December, 2015, 192 adult Sprague Dawley rats were divided into four groups: Avulsion, Pue 50 treatment, Pue 100 and Pue 200 groups. The right C5-C7nerve roots were avulsed through the methods of cervical dorsal approach. Puerarin or normal saline was given immediatedly once daily to the rats respectively by the intraperitoneal injection. The rats were killed at 1, 2, 4 and 6 weeks after injury. The paraffin sections of C7 segment were stained with neutral red. Expression of GAP-43 and NGF were detected by Western blot. Results Compared to the avuled group, the motoneuron survival rates of Pue 100 and Pue 200 dose treatment groups increased on the second week and the sixth week(P < 0.05 or P < 0.01), and the Pue 200 dose treatment group increased on the fourth week(P < 0.01).In the anterior horn of all three groups, expression of GAP-43 increased from the 1st week to the 6 week after the operation, and reached the peak at the 4th week, and decreased at the 6th week. Compared to the avuled group, expression of GAP-43 protein increased in the Pue 100 and Pue 200 dose treatment groups at the 1st week and 2nd week,the expression of NGF protein increased in the three Pue treatment groups at four time points(P < 0.05 or P < 0.01). Conclusion Puerarin can improve the survival rates of spinal motoneurons after the brachial plexus root avulsion, and the expression of GAP-43 and NGF increased, suggesting that Puerarin may play an role in the repair of brachial plexus avulsions by promoting the ex-pression of nerve growth factors.
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Objective To investigate the characteristics of electromyography(EMG) and MRI in the diagnosis of brachial plexus injury in newborns.Methods First,the EMG examination was conducted in 30 newborns with brachial plexus injury,where the brachial plexus of the five major nerve conduction and muscle EMG activity were measured.Second,the brachial plexus MRI was conducted to compare with the first examination.Results EMG revealed that 25 cases of upper and middle trunk palsy(83.3%),4 cases of total plexus palsy(13.3%) and 1 case of lower trunk palsy(3.3%) in the 30 cases,as well as 6 cases of plexus pre-ganglionic injury(20.0%),7 cases of complete injury(23.3%),23 cases of incomplete injury (76.7%).MRI showed that 5 cases of upper and middle trunk palsy(16.7%),1 case of total plexus palsy (3.3%),1 case of lower trunk palsy(3.3%),and 7 cases of plexus pre-ganglionic injury(23.3%)in the whole 30 cases.Conclusion EMG and MRI are both helpful to localize the brachial plexus injury.But EMG performs better compared with MRI towards the slight incomplete injury.Therefore,the combination of both methods can provide an accurate guidance for diagnosis.
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Breast cancer survivors often suffer from a variety of complications post operation, such as upper limb dysfunction, limb lymphedema, brachial plexus nerve injury, and so on. This article reviewed the pathogenesis and rehabilitation of these complications.
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Brachial plexus injury is regarded as one of the most devastating injuries of the upper extremity. Accurate diagnosis is important to obtain the successful results. Basic preoperative evaluation includes simple radiography, cervical myelography. Magnetic resonance imaging, angiography, electrophysiologic studies and intraoperative studies. Furthermore, proper timing of surgery, surgical indication, plan and sufficient understanding of patients about the prognosis are the key for the satisfactory outcomes. This article provides an overview of the evaluation, diagnosis, intraoperative monitoring, and proper surgical planning for the treatment of posttraumatic brachial plexus injuries.
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Humans , Angiography , Brachial Plexus , Diagnosis , Magnetic Resonance Imaging , Monitoring, Intraoperative , Myelography , Prognosis , Radiography , Upper ExtremityABSTRACT
The free functional muscle transfer (FFMT) is the surgical procedure aimed at reconstructing defective or deteriorated muscle function by grafting free muscles including blood vessels and nerves. Since the free gracilis transfer in the facial paralysis was introduced in 1976, there have been many studies and clinical applications of the FFMT in various donor and recipient sites in brachial plexus injury, muscle ischemic contracture, muscle defect after tumor resection, congenital muscular deficit, multiple trauma. When the reconstruction of the nerve is delayed for 9 months to 1 year after the brachial plexus injury, voluntary muscle contracture is impossible even after the nerve regeneration by the irreversible degeneration of the muscles. And it is difficult to obtain adequate function even if nerve transfer or nerve transplantation is performed because the distance to be regenerated is too long. In these cases, the FFMT has been improved the functions of the upper limb in flexion or extension of the elbow, fingers. Many good clinical results of the FFMT have been reported, so the FFMT gets much interests and attentions. The essential things for the successful outcome of the surgery are the anatomical knowledge, the skilled surgical technique and the choice of patients who can meet the indications and receive long-term rehabilitation. Recent advances in surgical techniques will result in improved results of the FFMT.
Subject(s)
Humans , Attention , Blood Vessels , Brachial Plexus , Contracture , Elbow , Facial Paralysis , Fingers , Ischemic Contracture , Multiple Trauma , Muscle, Skeletal , Muscles , Nerve Regeneration , Nerve Transfer , Rehabilitation , Tissue Donors , Transplants , Upper ExtremityABSTRACT
OBJECTIVE: To investigate the feasibility of using free gracilis muscle transfer along with the brachialis muscle branch of the musculocutaneous nerve to restore finger and thumb flexion in lower trunk brachial plexus injury according to an anatomical study and a case report. METHODS: Thirty formalin-fixed upper extremities from 15 adult cadavers were used in this study. The distance from the point at which the brachialis muscle branch of the musculocutaneous nerve originates to the midpoint of the humeral condylar was measured, as well as the length, diameter, course and branch type of the brachialis muscle branch of the musculocutaneous nerve. An 18-year-old male who sustained an injury to the left brachial plexus underwent free gracilis transfer using the brachialis muscle branch of the musculocutaneous nerve as the donor nerve to restore finger and thumb flexion. Elbow flexion power and hand grip strength were recorded according to British Medical Research Council standards. Postoperative measures of the total active motion of the fingers were obtained monthly. RESULTS: The mean length and diameter of the brachialis muscle branch of the musculocutaneous nerve were 52.66±6.45 and 1.39±0.09 mm, respectively, and three branching types were observed. For the patient, the first gracilis contraction occurred during the 4th month. A noticeable improvement was observed in digit flexion one year later; the muscle power was M4, and the total active motion of the fingers was 209°. CONCLUSIONS: Repairing injury to the lower trunk of the brachial plexus by transferring the brachialis muscle branch of the musculocutaneous nerve to the anterior branch of the obturator nerve using a tension-free direct suture is technically feasible, and the clinical outcome was satisfactory in a single surgical patient.
Subject(s)
Humans , Male , Adolescent , Tendon Transfer/methods , Brachial Plexus/injuries , Brachial Plexus Neuropathies/surgery , Fingers/physiology , Gracilis Muscle/surgery , Gracilis Muscle/innervation , Musculocutaneous Nerve/transplantation , Thumb/physiology , Cadaver , Feasibility Studies , Nerve Transfer/methods , Range of Motion, Articular/physiology , Hand Strength/physiology , Brachial Plexus Neuropathies/physiopathologyABSTRACT
BACKGROUND AND PURPOSE: Neuropathic pain (NeuP) associated with traumatic brachial plexus injury (BPI) can be severe, persistent, and resistant to treatment. Moreover, comorbidity associated with NeuP may worsen the pain and quality of life. This study compared persistent NeuP after BPI between patients with and without co-morbid conditions (psychiatric dysfunction and other painful conditions) and tramadol usage as a second-line agent in combination with an antiepileptic and/or antidepressant during a 2-year follow-up. METHODS: The medical records of patients diagnosed with BPI referred to a pain center between 2006 and 2010 were reviewed for 2 years retrospectively. Data regarding patient demographics, injury and surgical profiles, characteristics of NeuP and its severity, and treatment received were compared between patients with and without manifesting co-morbid conditions. The NeuP and pain intensity assessments were based on the DN4 questionnaire and a numerical rating scale, respectively. RESULTS: Of the 45 patients studied, 24 patients presented with one of the following co-morbid conditions: myofascial pain (21%), psychiatric disorder (17%), phantom limb pain (4%), complex regional pain syndrome (21%), and insomnia (37%). Tramadol was required by 20 patients with co-morbidity and, 9 patients without co-morbidity (p<0.001). The mean pain score after 2 years was higher in patients with co-morbidity than in those without co-morbidity (p<0.05). CONCLUSIONS: Persistent pain following BPI was more common in patients manifesting other painful conditions or psychiatric co-morbidity. A higher proportion of the patients in the co-morbid group required tramadol as a second-line of agent for pain relief.
Subject(s)
Adult , Humans , Brachial Plexus , Comorbidity , Demography , Follow-Up Studies , Medical Records , Neuralgia , Pain Clinics , Phantom Limb , Quality of Life , Retrospective Studies , Sleep Initiation and Maintenance Disorders , TramadolABSTRACT
OBJECTIVE: In gracilis functioning free muscle transplantation, the limited caliber of the dominant vascular pedicle increases the complexity of the anastomosis and the risk of vascular compromise. The purpose of this study was to characterize the results of using a T-shaped vascular pedicle for flow-through anastomosis in gracilis functioning free muscle transplantation for brachial plexus injury. METHODS: The outcomes of patients with brachial plexus injury who received gracilis functioning free muscle transplantation with either conventional end-to-end anastomosis or flow-through anastomosis from 2005 to 2013 were retrospectively compared. In the flow-through group, the pedicle comprised a segment of the profunda femoris and the nutrient artery of the gracilis. The recipient artery was interposed by the T-shaped pedicle. RESULTS: A total of 46 patients received flow-through anastomosis, and 25 patients received conventional end-to-end anastomosis. The surgical time was similar between the groups. The diameter of the arterial anastomosis in the flow-through group was significantly larger than that in the end-to-end group (3.87 mm vs. 2.06 mm, respectively, p<0.001), and there were significantly fewer cases of vascular compromise in the flow-through group (2 [4.35%] vs. 6 [24%], respectively, p=0.019). All flaps in the flow-through group survived, whereas 2 in the end-to-end group failed. Minimal donor-site morbidity was noted in both groups. CONCLUSIONS: Flow-through anastomosis in gracilis functioning free muscle transplantation for brachial plexus injury can decrease the complexity of anastomosis, reduce the risk of flap loss, and allow for more variation in muscle placement. .