United Brachial Plexus Network, Inc.

I am two years post accident and one year and a half post nerve transplant. Nothing has transpired from the nerve transplant, and now the Dr. wants to do a muscle tendon transfer. Has anybody gone through this procedure? What was the results?

Fredrick,
I had both a muscle transfer (Gracilis muscle from thigh to biceps region for elbow flexion) and tendon transfer (wrist flexor transfer to finger extensor to be able to open up my hand all the way). All of my surgeries were at the Mayo Clinic in Rochester MN and all surgeries were successful.

I'm truly sorry to hear that you nerve transfers didn't take. That wait with no return or progress must of been hell.

Who is your doctor and where were you treated, if you don't mind me asking. How soon after injury did you get reconstructive surgery? And what is the tendon transfer your doctor is thinking of?

Keep us updated.

Best of Luck,
Christopher

Fredrick,
My daughter had nerve and muscle transfer done May, 2007. She is able to flex her arm at the elbow to about 90 degrees and has some controllable extension. She has some hand movement, but not a whole lot. The tendon lengthening will be at a later date. All 5 of her nerves were avulsed. She will never have any sensation in her arm or hand because the sensory nerves in her chest were all damaged and unable to be transfered to her arm.

My nerve transplant was conducted 4 months post accident by Dr. Sanger at Froedtert hospital, Milwaukee, WI. He has mentioned a couple of techniques. One technique being muscle and tendon transfer, as you mentioned. Did you have the Gracilis muscle routed through the shoulder to the bicep? The other technique is transferring muscle within my forearm and inserting the muscle to the bicep and humurus. I have no bicep movement, and Dr. Sanger is hoping to acheive at least 90 degree flexion. Do you still need to wear a sling?

Fredrick,
My Gracilis is tied into the end of my collar bone then routed down by the biceps to the elbow area where the biceps naturally meets. I don't use a sling anymore, but did for the first 2 years, but this is also because my doctors transfered half of my good C7 nerve across my throat over to my deltoid, so it stays in socket pretty well now. FYI I am 4 1/2 post injury.

I don't know of Dr. Sanger, but since the Mayo Clinic is only a 4 hour drive from Milwaukee, have you ever thought of going there for a second opinion? I highly recommend it, they are some of the nations top specialists in the TBPI field. I think it would be worth it, at the very least to get some more input and possible other options for your specific situation.

Frederick,
I agree with Christopher about getting a second opinion from Mayo. We live in Neenah and travel to Mayo for Dustin's TBPI.

Dustin is scheduled for the gracilis transfer in Aug. The second surgery you talk about was one of the choices they gave to Dustin, I think they called it a "Snap" after the dr that first preformed the operation. The third choice he had was a tricep tranfer as his tricep is strong. After much dicussion we decided the gracilis seemed to be the best option for Dustin. Reason being with tricep tranfer you lose the ability to straighten the arm unless using gravity to help. So you can't push away from your body or support weight to push yourself up. We felt if he had bicep it may be useful to keep the tricep. With the "Snap" they said they use the group of muscles below the elbow. This is the group of muscles that also control wrist flexion but many people don't learn to use that group of muscles without flexing the wrist. So when bending up the elbow it may require flicking up the wrist. This could be a bad situation if holding something; say hot drink, knife, ect.. in the hand. They also said that they have best result with this surgery if you have some bicep because it will enhance what is there but will not be enough to bend the elbow alone and not enough to hold much weight while bending the elbow. So, I am a little concerned if this is the same surgery that your dr recommends. It sounds the same, but I may be wrong. These may be questions you will want to ask him. So, with this knowledge we felt that the gracilis, although the most difficult would give the best results and use of the arm.

Sue

With the gracilis transfer,how was the scaring. They are talking about that possibly being the next step for my daughter... She already has a few pretty big scars (like everyone else), but when they transfered the ulnar nerve for the contra lateral C7 that scar was significantly longer. Her legs right now are unscarred, and she (and I) are curious of the length of the incesion on the leg, and do they use the existing incision on her arm?

Roger

Dustin was wondering about scarring also. He already looks like he got the short end of a knife fight. Anyone willing to share a link to Gracilis scars?
Thanks, Sue

Roger,
Mel had her gracilis muscle transfer along with the nerve transfers so she received several new scars. The gracilis scar on her inner thigh is about 5 to 6 inches long and is not really noticeable unless she shows you. They used the same incision on her arm that was used originally to repair her fractured humerus with the original trauma. With the gracilis transfer they do like to put a skin "paddle" up by the shoulder so they can monitor the vascular status to the muscle transfer. They take the skin from the same area they take the gracilis muscle, the inner thigh. It's a football shaped piece of skin. The only thing they told us which was a little unnerving for my daughter was that if you have a lot of hair that grows on this skin in your inner thigh than this same hair will then grow again on your shoulder. Thank goodness, Melanie is not very hairy, so it was not noticeable. They can remove the "paddle" after at least one year post op. Mel is getting her's removed this October. After her surgery, of course she was in a full arm cast with an abductor pillow and immobilizer for 3 weeks, then a partial splint and sling for another 3 weeks and then eventually nothing after that. She just wasn't allowed to have her arm fall down at her side so as not to rip any new tendon growth. They did use nerves from her left leg also. Her sural nerve was used so she has a long scar up the back of her leg from ankle to knee. She also has a couple small scars from the drains they put in her after surgery. All of her scars are fading and are nearly as noticeable as they once were. The doctors at Mayo knew that scarring was a big concern of my daughter so they took that into consideration and had a plastic surgeon in on things especially for the incision under her breast where they transferred nerves from the intercostals to her arm.

My son just had the muscle and tendon transplant done on July 15th. The insisions on is leg goes from his groin to about half way down his thigh, 27 staples and at his knee the insision looks like a V and is has 12 staples. On his arm there are 2 V shaped insisions, one at his inner wrist, 12 staples and one just below his inner elbow that is bigger and it has stiches. At the elbow there is a open drain like and it looks pretty nasty. There is still the probes on his forearm and there is 4 staples in that. Cody also has a neat little insision from his wrist going a down a little bit on his palm.

Cody's accident was 8-18-04, so it's been almost 3 years. Cody got has 5 nerve root avulsions. Cody got back from the first surgery his bicep and tricep. He also got elbow and wrist flexion. And trace movement in his thumb.

I think that I would also get a second opnion. Cody's dr. is Dr. Nath in Houston, TX.

Good Luck,

Cody's mom, Robin