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Evaluation of Functional Outcome of Trapezius, Gracilis and Modified Quad Procedures in Brachial Plexus Injury: A Prospective Observational Study |
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Pinal Rajubhai Pipaliya, Dhaval Dilipbhai Vanzara, Hiren Arvind Bhai Rana, Chetan Jayantilal Prajapati, Manav Parveshcander Suri, Jayesh Prafulchandra Sachde 1. Assistant Professor, Department of Plastic Surgery, PDU Civil Hospital, Rajkot, Gujarat, India. 2. Assistant Professor, Department of Burns and Plastic Surgery, Civil Hospital, Ahmedabad, Gujarat, India. 3. Associate Professor, Department of Burns and Plastic Surgery, Civil Hospital, Ahmedabad, Gujarat, India. 4. Associate Professor, Department of General Surgery, Dr. M.K. Shah Medical College and Research Centre, Ahmedabad, Gujarat, India. 5. Professor, Department of Burns and Plastic Surgery, Civil Hospital, Ahmedabad, Gujarat, India. 6. Professor and Head, Department of Burns and Plastic Surgery, Civil Hospital, Ahmedabad, Gujarat, India. |
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Correspondence Address : Dr. Hiren Arvind Bhai Rana, 103, Mithila-1, Government Colony, Opp. Tatanagar Society, Meghaninagar, Asarwa-380016, Ahmedabad, Gujarat, India. E-mail: pinalpipaliya@gmail.com |
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| ABSTRACT |  | ||||||
: Introduction: In the early 19th century, well before the advent of microsurgical tools, surgeons reported encouraging results in brachial plexus reconstruction. By the late 1990s, aggressive reconstructions using extraplexal sources and vascularised muscle transfers were being reported. Some studies suggest that in late presentations, primary nerve transfer offers limited benefit; in such cases, muscle or tendon transfer (pedicled or free) is preferred. In low- and middle-income settings, delayed presentation (>12 months) is common, and prospective outcome data for muscle and tendon transfers in this cohort remain sparse. Aim: To evaluate the functional outcomes of muscle and tendon transfers in late-presenting Brachial Plexus Injury (BPI) (>12 months), stratified by injury level (pre vs post-ganglionic) and aetiology {adult traumatic BPI vs Obstetric Brachial Plexus Palsy (OBPP)}. Materials and Methods: A prospective observational study was conducted in the Department of Burns and Plastic Surgery, Civil Hospital Ahmedabad, Gujarat, India and the Department of General Surgery, Dr. MK Shah Medical College and Research Centre, Ahmedabad, Gujarat, India, from June 2022 to February 2024. A total of 40 consecutive patients presenting more than one year after injury were included. Variables assessed included age, gender, side involved, mechanism of trauma, injury level, procedures performed, and duration of follow-up. Primary outcomes were the Medical Research Council (MRC) grade for elbow flexion and shoulder abduction range measured in degrees. Secondary outcomes included external rotation, ability to perform activities of daily living, complications and donor-site morbidity, and the need for reoperation. Results: The mean age of the cohort was 25.8 years; the mean age of males was 27.4 years and of females was 21.1 years. Among the 40 patients with BPI, the mechanism of injury was road traffic trauma in 32 patients (80%) and OBPP in 8 (20%) patients. Lesions were pre-ganglionic in 24 patients (60%) and post-ganglionic in 16 patients (40%). The right upper limb was involved in 28 patients (70%). Anatomically, 14 patients (35%) had upper-trunk injuries, while 26 patients (65%) had pan-plexus involvement. Among those who underwent Free Functioning Muscle Transfer (FFMT) for elbow flexion (n=8), six patients achieved ≥M3 strength at the 18-month follow-up (75%), and two patients achieved M2 strength (25%). In the upper trapezius transfer group (n=24), all patients demonstrated atleast a 40° improvement in shoulder abduction. A gain of 40-50° was observed in 12 patients (50%), 50-60° in 8 (33.3%) patients and 30-40° in 4 (16.7%) patients. Overall, eight out of 24 patients (33.3%) achieved an abduction gain of ≥50°. Conclusion: In developing countries such as India, early referral is critical. Primary nerve reconstruction remains the preferred option within approximately six months of injury, whereas muscle and tendon transfers provide reliable functional gains in late presenters and as salvage procedures after failed primary reconstruction. | |||||||
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| Keywords : Elbow flexion, Grafting, Musculocutaneous nerve | |||||||
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DOI and Others :
DOI: 10.7860/IJARS/2026/82294.3087
Date of Submission: Jul 25, 2025 Date of Peer Review: Oct 18, 2025 Date of Acceptance: Dec 18, 2025 Date of Publishing: Mar 01, 2026 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was Ethics Committee Approval obtained for this study? Yes • Was informed consent obtained from the subjects involved in the study? Yes • For any images presented appropriate consent has been obtained from the subjects. NA PLAGIARISM CHECKING METHODS: • Plagiarism X-checker: Aug 28, 2025 • Manual Googling: Dec 11, 2025 • iThenticate Software: Dec 17, 2025 (7%) ETYMOLOGY: Author Origin EMENDATIONS: 7 |
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