Restoration of elbow flexion after brachial plexus injury: the role of nerve and muscle transfers.

Brachial plexus trauma results in a variable loss of upper extremity function. The restoration of this function requires elbow flexion of adequate strength and range of motion. A proper evaluation of brachial plexus lesions is a prerequisite to any reconstructive procedure, and appropriate guidelines are presented. One option for restoring elbow flexion is a nerve transfer. The best results with this procedure are obtained in young patients treated within 6 months of injury. Another option is a free or pedicled muscle transfer, which should be considered in older patients or patients treated more than 6 months after an injury. Muscle transfers may also be used to augment the results of nerve transfer procedures. Choices and clinical results of donor nerves and muscle for transfer are discussed, and an algorithm for treatment is presented.