Is gracillis transfer necessary?
-
GMcG
Is gracillis transfer necessary?
This may sound silly or simple minded, but does anyone know if the gracillis muscle transfer is absolutely necessary for nerve transfer surgery? My entire b.p was avulsed save the C5 it seems, so I don't have any bicep function, but I can't get the dr's at Mayo to give me an answer on this ( or some other questions...) until I go back for surgery. In the meantime, I'm freaking out and trying to make decisions. Ugh.
Re: Is gracillis transfer necessary?
No it's not. They first scheduled Dustin for a nerve transfer. This would have been from behind the calves on his leg. Sorry don't remember the name. This was the nerve transfer surgery. When they opened him up nothing was avulsed. The second surgery was the gracilis transfer. This they scheduled later as nothing was avulsed and they wanted to see what would heal before performing the gracilis transfer. The nerve surgeries are kind of on a "time is of the essence" but the gracilis may be done at anytime is what they told us at the Mayo. However if they want to do it all at once they probably feel this would give you the most function. I know some people have had them both at the same time and others had them done seperately. I think now they prefer do them at the same time if needed.
Sue
Message was edited by: ptrefam
Message was edited by: ptrefam
Sue
Message was edited by: ptrefam
Message was edited by: ptrefam
-
marieke
- Posts: 1627
- Joined: Fri Apr 01, 2005 6:00 pm
- Injury Description, Date, extent, surgical intervention etc: LOBPI
no external rotation against gravity, can only go to 90 degree fwd flexion, no hand-to-mouth
1 surgery at age 14 (latissimus dorsi transfer). In 2004, at age 28 I was struck with Transverse Myelitis which paralyzed me from the chest down. I recovered movement to my right leg, but need a KAFO to walk on my left leg. I became an RN in 2008. - Location: Montreal, Qc, Canada
- Contact:
Re: Is gracillis transfer necessary?
The nerve behind the leg/calf they use is the Sural Nerve I think...
Marieke (31, LOBPI)
Marieke (31, LOBPI)
-
Christopher
- Posts: 845
- Joined: Wed Jun 18, 2003 10:09 pm
- Injury Description, Date, extent, surgical intervention etc: Date of Injury: 12/15/02
Level of Injury:
-dominant side C5, C6, & C7 avulsed. C8 & T1 stretched & crushed
BPI Related Surgeries:
-2 Intercostal nerves grafted to Biceps muscle,
-Free-Gracilis muscle transfer to Biceps Region innervated with 2 Intercostal nerves grafts.
-2 Sural nerves harvested from both Calves for nerve grafting.
-Partial Ulnar nerve grafted to Long Triceps.
-Uninjured C7 Hemi-Contralateral cross-over to Deltoid muscle.
-Wrist flexor tendon transfer to middle, ring, & pinky finger extensors.
Surgical medical facility:
Brachial Plexus Clinic at The Mayo Clinic, Rochester MN
(all surgeries successful)
"Do what you can, with what you have, where you are."
~Theodore Roosevelt - Location: Los Angeles, California USA
Re: Is gracillis transfer necessary?
Hi Genevieve,
I'm not sure I fully understand your question. But what I think you're asking, is that "is it necessary to have a nerve transferred if one gets a gracilus muscle transfer as well". Is that about right?
If you get a gracilus muscle transfer, it has to have adequate nerve supply for the muscle to work. Since most of us have the problem of not having any, or not nerve supply, nerve transfers are essential for any return of function/movement. If the docs at the Mayo Clinic are negotiating a gracilus muscle transfer, then most likely that would include a nerve transferred as well.
Depending on how long ago your injury was, transferring nerves to the bicep from your rib cage (intercostal nerves) could be done to give you some biceps function. But if you're surgery is to happen after the six-month mark from your accident, then your bicep muscle would be too far gone to save most likely. That's when they opt for a muscle transfer. I had a muscle transfer to the bicep area, and a nerve transfer to my bicep muscle as well. Both of those being innervated by intercostal nerves. The idea was to give my elbow flexion more power than by just innervating the bicep alone.
I wish you the best of luck,
Chris
PS if you want to give me a ring and talk about any of this, feel free. You can click my name to access my e-mail address if you don't still have my number. I hope you are hanging in there. I know how tough this is.
I'm not sure I fully understand your question. But what I think you're asking, is that "is it necessary to have a nerve transferred if one gets a gracilus muscle transfer as well". Is that about right?
If you get a gracilus muscle transfer, it has to have adequate nerve supply for the muscle to work. Since most of us have the problem of not having any, or not nerve supply, nerve transfers are essential for any return of function/movement. If the docs at the Mayo Clinic are negotiating a gracilus muscle transfer, then most likely that would include a nerve transferred as well.
Depending on how long ago your injury was, transferring nerves to the bicep from your rib cage (intercostal nerves) could be done to give you some biceps function. But if you're surgery is to happen after the six-month mark from your accident, then your bicep muscle would be too far gone to save most likely. That's when they opt for a muscle transfer. I had a muscle transfer to the bicep area, and a nerve transfer to my bicep muscle as well. Both of those being innervated by intercostal nerves. The idea was to give my elbow flexion more power than by just innervating the bicep alone.
I wish you the best of luck,
Chris
PS if you want to give me a ring and talk about any of this, feel free. You can click my name to access my e-mail address if you don't still have my number. I hope you are hanging in there. I know how tough this is.
-
GMcG
Re: Is gracillis transfer necessary?
It is almost 6 mos. after my initial injury. My question is sort of the reverse-- is it necessary to have the gracillis transfer if I'm going to have the nerve transfer done? I am only going for shoulder and elbow movement back, not tricep or hand.
My stomach is in knots, and though it may sound controversial, I am willing to settle for moderate amount of function return (comparitively, I realize these operations can only return very little of what I used to have.) I amlooking at my overall quality of life, not only in the long run but over the next several years and with the rest of my body; Not only do I not want to not want to regret not having this surgery, but I do not want to regret this operation, what it does to reduce my sensations, scar my body, all for relatively very little return of function. I am comfortable with a lower scale nerve transfer rather than trying for everything back I can, only to be disappointed, and would rather try to save as much as I can of what remains of my healthy body, intact. I am having a hard time getting people -- and surgeons -- to understand this. Any suggestions?
And yes, I still have your # Cris, ok to call...?
My stomach is in knots, and though it may sound controversial, I am willing to settle for moderate amount of function return (comparitively, I realize these operations can only return very little of what I used to have.) I amlooking at my overall quality of life, not only in the long run but over the next several years and with the rest of my body; Not only do I not want to not want to regret not having this surgery, but I do not want to regret this operation, what it does to reduce my sensations, scar my body, all for relatively very little return of function. I am comfortable with a lower scale nerve transfer rather than trying for everything back I can, only to be disappointed, and would rather try to save as much as I can of what remains of my healthy body, intact. I am having a hard time getting people -- and surgeons -- to understand this. Any suggestions?
And yes, I still have your # Cris, ok to call...?
Re: Is gracillis transfer necessary?
The gracilis and sural nerve transplants may be done at different times. Or, you may choose not to have the gracilis at all. This was Dustin's choice. We had even scheduled the surgery. He has full hand and some shoulder, enough to keep it in socket and he's having no problems, he also has tricepts. They were going to do the gracilis transfer in him for elbow flexion/bicept. He wanted to be able to have a "functional" arm. However, after we arrived at Mayo, the day prior to surgery, at his appt we asked several more questions. The answers were not quite what we had understood at the time he decided he wanted the surgery. Think it was all so overwhelming, or maybe we just asked different questions. I'm not sure. Anyway after some more discussion he too decided he wasn't ready for that surgery at this time. He does not want any more scars. They also told him he would have about 5-7 lb usage (I don't know if this is the norm). So, he decided that for now he does not want the surgery. They did say that if he should change his mind the surgery could be performed at any time. I think the reason they are talking about the gracilis for you is for bicept or elbow flexion. This is how it sounds from how you are describing it. This is what it would have done for Dustin. He also has tricepts. Just mostly waiting on bicept and more shoulder would be nice.
Sue
Sue