Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Orthopedic Surgery

Brachial plexus injuriesmay lead to severe upper limb disability.When other options for reconstruction of upper extremity function are not possible, the free functioning muscle transfer (FFMT) is used as a salvage procedure. Our study analyzed the functional outcome of the use of FFMTin improving the elbow and hand functions in the pediatric age group.We included 11 children with brachial plexus paralysiswhich was either obstetric or traumatic in origin and where other options for upper limb reanimation were not available. Hand functions were assessed using mean total active motion (TAM) fingers, Doi's modified medical research council (MRC) grading, Raimondi scoring and the 6 prehensile functions described by Schlesinger. While the elbow function was assessed using modified (MRC) muscle strength grading and the active movement scale (AMS). Patients were followed for a period ranging from 12 months to 29 months with a mean of 18.8 months. We found by the end of this study that the FFMT is useful to restore elbow flexion, but not satisfactory to the patients when used to improve hand functions. This is due to the complexity of these functions that could not be restored by a single muscle. Even with an FFMT, the hand will always remain a helping hand

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