{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T23:31:28Z","timestamp":1773012688300,"version":"3.50.1"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2016,3,3]],"date-time":"2016-03-03T00:00:00Z","timestamp":1456963200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2016,3,3]],"date-time":"2016-03-03T00:00:00Z","timestamp":1456963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>In the study, the functional recovery and relative comprehensive quality of life of cases of global brachial plexus treated with free functioning muscle transfers were investigated. Patients who received functioning gracilis muscle transfer between August 1999 and October 2014 to reconstruct elbow flexion, wrist and fingers extension were recruited. The mean age of the patients was 26.36 (range, 16\u201342) years. The mean period of time from gracilis transfer to the last follow-up was 54.5 months (range, 12\u2013185 months). Muscle power, active range of motion of the elbow flexion, wrist extension and total active fingers extension were recorded. SDS, SAS and DASH questionnaires were given to estimate patients\u2019 quality of life. 35.71% reported good elbow flexion and 50.00% reported excellent elbow flexion. The average ROM of the elbow flexion was 106.5\u00b0 (range, 0\u2013142\u00b0) and was 17.00\u00b0 (range, 0\u201372\u00b0) for wrist extension. The average DASH score was 51.14 (range, 17.5\u201390.8). The prevalence of anxiety and depression were 42.86% and 45.24%. Thrombosis and bowstringing were the most common short and long-term complications. Based on these findings, free gracilis transfer using accessory nerve as donor nerve is a satisfactory treatment to reconstruct the elbow flexion and wrist extension in global-brachial-plexus-injured patients.<\/jats:p>","DOI":"10.1038\/srep22479","type":"journal-article","created":{"date-parts":[[2016,3,3]],"date-time":"2016-03-03T10:21:29Z","timestamp":1457000489000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Functioning free gracilis transfer to reconstruct elbow flexion and quality of life in global brachial plexus injured patients"],"prefix":"10.1038","volume":"6","author":[{"given":"Yi","family":"Yang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian-Tao","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guo","family":"Fu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiang-Ming","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ben-Gang","family":"Qin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Hou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Qi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ping","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao-Lin","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li-Qiang","family":"Gu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2016,3,3]]},"reference":[{"key":"BFsrep22479_CR1","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/j.ijsu.2008.01.004","volume":"6","author":"MA Hosseinian","year":"2008","unstructured":"Hosseinian, M. A. & Tofigh, A. M. Cross pectoral nerve transfer following free gracilis muscle transplantation for chronic brachial plexus palsy: a case series. Int J Surg 6, 125\u2013128 (2008).","journal-title":"Int J Surg"},{"key":"BFsrep22479_CR2","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1097\/00006534-197602000-00001","volume":"57","author":"K Harii","year":"1976","unstructured":"Harii, K., Ohmori, K. & Torii, S. Free gracilis muscle transplantation, with microneurovascular anastomoses for the treatment of facial paralysis. A preliminary report. Plast Reconstr Surg 57, 133\u2013143 (1976).","journal-title":"Plast Reconstr Surg"},{"key":"BFsrep22479_CR3","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1016\/S0363-5023(78)80134-8","volume":"3","author":"RT Manktelow","year":"1978","unstructured":"Manktelow, R. T. & McKee, N. H. Free muscle transplantation to provide active finger flexion. J Hand Surg Am 3, 416\u2013426 (1978).","journal-title":"J Hand Surg Am"},{"key":"BFsrep22479_CR4","first-page":"454","volume":"8","author":"Y Ikuta","year":"1979","unstructured":"Ikuta, Y., Yoshioka, K. & Tsuge, K. Free muscle graft as applied to brachial plexus injury-case report and experimental study. Ann Acad Med Singapore 8, 454\u2013458 (1979).","journal-title":"Ann Acad Med Singapore"},{"key":"BFsrep22479_CR5","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1016\/0363-5023(93)90363-8","volume":"18","author":"DC Chuang","year":"1993","unstructured":"Chuang, D. C., Epstein, M. D., Yeh, M. C. & Wei, F. C. Functional restoration of elbow flexion in brachial plexus injuries: results in 167 patients (excluding obstetric brachial plexus injury). J Hand Surg Am 18, 285\u2013291 (1993).","journal-title":"J Hand Surg Am"},{"key":"BFsrep22479_CR6","doi-asserted-by":"publisher","first-page":"652","DOI":"10.2106\/00004623-200005000-00006","volume":"82","author":"K Doi","year":"2000","unstructured":"Doi, K. et al. Restoration of prehension with the double free muscle technique following complete avulsion of the brachial plexus. Indications and long-term results. J Bone Joint Surg Am 82, 652\u2013666 (2000).","journal-title":"J Bone Joint Surg Am"},{"key":"BFsrep22479_CR7","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.1097\/00006534-199910000-00001","volume":"104","author":"JK Terzis","year":"1999","unstructured":"Terzis, J. K., Vekris, M. D. & Soucacos, P. N. Outcomes of brachial plexus reconstruction in 204 patients with devastating paralysis. Plast Reconstr Surg 104 1221\u20131240 (1999).","journal-title":"Plast Reconstr Surg"},{"key":"BFsrep22479_CR8","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1227\/01.neu.0000303197.87672.31","volume":"61","author":"M Ahmed-Labib","year":"2007","unstructured":"Ahmed-Labib, M., Golan, J. D. & Jacques, L. Functional outcome of brachial plexus reconstruction after trauma. Neurosurgery 61, 1016\u20131022 (2007).","journal-title":"Neurosurgery"},{"key":"BFsrep22479_CR9","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1016\/S0363-5023(97)80116-5","volume":"22","author":"PD Choi","year":"1997","unstructured":"Choi, P. D., Novak, C. B., Mackinnon, S. E. & Kline, D. G. Quality of life and functional outcome following brachial plexus injury. J Hand Surg Am 22, 605\u2013612 (1997).","journal-title":"J Hand Surg Am"},{"key":"BFsrep22479_CR10","doi-asserted-by":"publisher","first-page":"1505","DOI":"10.2106\/JBJS.K.01279","volume":"95","author":"C Dodakundi","year":"2013","unstructured":"Dodakundi, C. et al. Outcome of surgical reconstruction after traumatic total brachial plexus palsy. J Bone Joint Surg Am 95, 1505\u20131512 (2013).","journal-title":"J Bone Joint Surg Am"},{"key":"BFsrep22479_CR11","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1142\/S0218810406003279","volume":"11","author":"I Kitajima","year":"2006","unstructured":"Kitajima, I., Doi, K., Hattori, Y., Takka, S. & Estrella, E. Evaluation of quality of life in brachial plexus injury patients after reconstructive surgery. Hand Surg 11, 103\u2013107 (2006).","journal-title":"Hand Surg"},{"key":"BFsrep22479_CR12","doi-asserted-by":"publisher","first-page":"544","DOI":"10.6061\/clinics\/2015(08)03","volume":"70","author":"Y Hou","year":"2015","unstructured":"Hou, Y. et al. Flow-through anastomosis using a T-shaped vascular pedicle for gracilis functioning free muscle transplantation in brachial plexus injury. Clinics (Sao Paulo) 70, 544\u2013549 (2015).","journal-title":"Clinics (Sao Paulo)"},{"key":"BFsrep22479_CR13","first-page":"e120234","volume":"10","author":"SB Chen","year":"2015","unstructured":"Chen, S. B. et al. Prevalence of clinical anxiety, clinical depression and associated risk factors in chinese young and middle-aged patients with osteonecrosis of the femoral head. PLoS One 10, e120234 (2015).","journal-title":"PLoS One"},{"key":"BFsrep22479_CR14","doi-asserted-by":"publisher","first-page":"1839","DOI":"10.4103\/1673-5374.131602","volume":"9","author":"G Fu","year":"2014","unstructured":"Fu, G. et al. Penile erectile dysfunction after brachial plexus root avulsion injury in rats. Neural Regen Res 9, 1839\u20131843 (2014).","journal-title":"Neural Regen Res"},{"key":"BFsrep22479_CR15","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1055\/s-0033-1357498","volume":"30","author":"J Yang","year":"2014","unstructured":"Yang, J. et al. Modified pathological classification of brachial plexus root injury and its MR imaging characteristics. J Reconstr Microsurg 30, 171\u2013178 (2014).","journal-title":"J Reconstr Microsurg"},{"key":"BFsrep22479_CR16","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1007\/s11552-009-9223-6","volume":"5","author":"JK Terzis","year":"2010","unstructured":"Terzis, J. K. & Kostopoulos, V. K. Free Muscle Transfer in Posttraumatic Plexopathies Part II: The Elbow. Hand (N Y) 5, 160\u2013170 (2010).","journal-title":"Hand (N Y)"},{"key":"BFsrep22479_CR17","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1016\/j.bjps.2009.05.021","volume":"63","author":"S Kay","year":"2010","unstructured":"Kay, S. et al. Microvascular free functioning gracilis transfer with nerve transfer to establish elbow flexion. J Plast Reconstr Aesthet Surg 63, 1142\u20131149 (2010).","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"BFsrep22479_CR18","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1177\/229255031402200105","volume":"22","author":"K Elzinga","year":"2014","unstructured":"Elzinga, K. et al. Double free gracilis muscle transfer after complete brachial plexus injury: First Canadian experience. Can J Plast Surg 22, 26\u201329 (2014).","journal-title":"Can J Plast Surg"},{"key":"BFsrep22479_CR19","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1002\/micr.22148","volume":"34","author":"YK Tu","year":"2014","unstructured":"Tu, Y. K. et al. Surgical treatment for total root avulsion type brachial plexus injuries by neurotization: a prospective comparison study between total and hemicontralateral C7 nerve root transfer. Microsurgery 34, 91\u2013101 (2014).","journal-title":"Microsurgery"},{"key":"BFsrep22479_CR20","doi-asserted-by":"publisher","first-page":"821","DOI":"10.2106\/JBJS.L.00039","volume":"95","author":"SF Wang","year":"2013","unstructured":"Wang, S. F. et al. Contralateral C7 nerve transfer with direct coaptation to restore lower trunk function after traumatic brachial plexus avulsion. J Bone Joint Surg Am 95, 821\u20137, S1-2 (2013).","journal-title":"J Bone Joint Surg Am"},{"key":"BFsrep22479_CR21","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1046\/j.1445-2197.2003.02654.x","volume":"73","author":"A Sungpet","year":"2003","unstructured":"Sungpet, A., Suphachatwong, C. & Kawinwonggowit, V. Transfer of one fascicle of ulnar nerve to functioning free gracilis muscle transplantation for elbow flexion. Anz J Surg 73, 133\u2013135 (2003).","journal-title":"Anz J Surg"},{"key":"BFsrep22479_CR22","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/j.hcl.2007.02.001","volume":"23","author":"DC Chuang","year":"2007","unstructured":"Chuang, D. C. Neurotization and free muscle transfer for brachial plexus avulsion injury. Hand Clin 23, 91\u2013104 (2007).","journal-title":"Hand Clin"},{"key":"BFsrep22479_CR23","doi-asserted-by":"publisher","first-page":"E8","DOI":"10.3171\/foc.2004.16.5.9","volume":"16","author":"KA Barrie","year":"2004","unstructured":"Barrie, K. A., Steinmann, S. P., Shin, A. Y., Spinner, R. J. & Bishop, A. T. Gracilis free muscle transfer for restoration of function after complete brachial plexus avulsion. Neurosurg Focus 16, E8 (2004).","journal-title":"Neurosurg Focus"},{"key":"BFsrep22479_CR24","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1016\/S0363-5023(96)80318-2","volume":"21","author":"DC Chung","year":"1996","unstructured":"Chung, D. C., Carver, N. & Wei, F. C. Results of functioning free muscle transplantation for elbow flexion. J Hand Surg Am 21, 1071\u20131077 (1996).","journal-title":"J Hand Surg Am"},{"key":"BFsrep22479_CR25","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1002\/micr.22502","volume":"22","author":"TA El-Gammal","year":"2002","unstructured":"El-Gammal, T. A., El-Sayed, A. & Kotb, M. M. Shoulder fusion and free-functioning gracilis transplantation in patients with elbow and shoulder paralysis caused by poliomyelitis. Microsurg 22, 199\u2013203 (2002).","journal-title":"Microsurg"},{"key":"BFsrep22479_CR26","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1097\/00006534-199309001-00023","volume":"92","author":"DC Chuang","year":"1993","unstructured":"Chuang, D. C., Wei, F. C. & Noordhoff, M. S. Cross-chest C7 nerve grafting followed by free muscle transplantations for the treatment of total avulsed brachial plexus injuries: a preliminary report. Plast Reconstr Surg 92, 717\u2013727 (1993).","journal-title":"Plast Reconstr Surg"},{"key":"BFsrep22479_CR27","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1177\/1753193409348182","volume":"35","author":"J Gousheh","year":"2010","unstructured":"Gousheh, J. & Arasteh, E. Upper limb functional restoration in old and complete brachial plexus paralysis. J Hand Surg Eur Vol 35, 16\u201322 (2010).","journal-title":"J Hand Surg Eur Vol"},{"key":"BFsrep22479_CR28","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.hcl.2006.12.004","volume":"23","author":"RM Zuker","year":"2007","unstructured":"Zuker, R. M. & Manktelow, R. T. Functioning free muscle transfers. Hand Clin 23, 57\u201372 (2007).","journal-title":"Hand Clin"},{"key":"BFsrep22479_CR29","doi-asserted-by":"publisher","first-page":"1348","DOI":"10.1097\/00006534-200011000-00020","volume":"106","author":"KA Gutowski","year":"2000","unstructured":"Gutowski, K. A. & Orenstein, H. H. Restoration of elbow flexion after brachial plexus injury: the role of nerve and muscle transfers. Plast Reconstr Surg 106, 1348\u20131359 (2000).","journal-title":"Plast Reconstr Surg"},{"key":"BFsrep22479_CR30","doi-asserted-by":"publisher","first-page":"1182","DOI":"10.1016\/j.jhsa.2011.02.025","volume":"36","author":"PS Bhandari","year":"2011","unstructured":"Bhandari, P. S. & Deb, P. Dorsal approach in transfer of the distal spinal accessory nerve into the suprascapular nerve: histomorphometric analysis and clinical results in 14 cases of upper brachial plexus injuries. J Hand Surg Am 36, 1182\u20131190 (2011).","journal-title":"J Hand Surg Am"},{"key":"BFsrep22479_CR31","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1097\/01.bth.0000236986.43170.66","volume":"10","author":"AI Addosooki","year":"2006","unstructured":"Addosooki, A. I., Doi, K. & Hattori, Y. Technique of harvesting the gracilis for free functioning muscle transplantation. Tech Hand Up Extrem Surg 10, 245\u2013251 (2006).","journal-title":"Tech Hand Up Extrem Surg"},{"key":"BFsrep22479_CR32","doi-asserted-by":"publisher","first-page":"2037","DOI":"10.1097\/PRS.0b013e3181706f3c","volume":"121","author":"K Doi","year":"2008","unstructured":"Doi, K. et al. Importance of early passive mobilization following double free gracilis muscle transfer. Plast Reconstr Surg 121, 2037\u20132045 (2008).","journal-title":"Plast Reconstr Surg"},{"key":"BFsrep22479_CR33","doi-asserted-by":"publisher","first-page":"A189","DOI":"10.1227\/01.NEU.0000335646.31980.33","volume":"65","author":"T Kretschmer","year":"2009","unstructured":"Kretschmer, T. et al. Patient satisfaction and disability after brachial plexus surgery. Neurosurgery 65, A189\u2013196 (2009).","journal-title":"Neurosurgery"},{"key":"BFsrep22479_CR34","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1017\/S1121189X00001421","volume":"18","author":"RC Kessler","year":"2009","unstructured":"Kessler, R. C. et al. The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr Soc 18, 23\u201333 (2009).","journal-title":"Epidemiol Psichiatr Soc"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/srep22479","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/srep22479.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/srep22479.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T13:31:35Z","timestamp":1672839095000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/srep22479"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,3,3]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2016,4,20]]}},"alternative-id":["BFsrep22479"],"URL":"https:\/\/doi.org\/10.1038\/srep22479","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,3,3]]},"assertion":[{"value":"2 October 2015","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 February 2016","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 March 2016","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing financial interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"22479"}}