United Brachial Plexus Network, Inc.

Hi! I haven't posted on here in awhile. Some background: my husband was injured in a ATV accident in Nov 2003. I can never remember the nerves that were damaged, but he is unable to use his bicep & shoulder, his hand, wrist & tricep work fine. He had a nerve transfer surgery done in Feb 2004 by Dr Nath. For some reason this surgery did not work... Not sure why... In April we are going back to Houston to have a muscle transfer surgery done, which will also include more nerve transfers. Dr Nath will be involved in the surgery, but the main surgeon will be Dr Boutros. Has anyone here had the muscle transfer surgery? They are going to take a muscle from his back & put it in his bicep. We will be in Houston for almost 3 weeks... Any feedback would be greatly appreciated! Thanks!

Jessica

It sounds like the Lattisimus dorsi transfer, if you do a search under lats and muscle transfer there are a lot of threads under it. I got the lats transfer in December but it was put in my shoulder rather than my biceps, to give external rotation. It hasn't really worked as of yet but apparently it take a while to build up. It is more commonly used for biceps use especially in adults.

Thank you for the info. Who did your surgery? How was the pain after surgery? My husband is really worried about the pain & the outcome. He will also be having skin graphs done. How long were you in the hospital? They say my husband will be in 4-5 days, but we are staying in Houston almost 3 weeks so they can keep a close eye on him. And, they are going to be putting in a drain that will be taken out before we leave for home. Again, thanks!

My daughter had a gracilis muscle transfer from her left inner thigh to her right bicep May 2006 at the Mayo Clinic in Rochester MN by Drs. Shin, Bishop and Spinner, along with several nerve transfers. She was in the hospital for 3 days and then we stayed close by the hospital for 4 days following that. I can't say first hand how the pain was, but she was on a morphine PCA pump for the first day and a half and then onto percocet afterward. I think her usual nerve pain was initially aggravated by the surgery and that's what caused the most pain of all. The morphine made her nauseated also. The drains aren't too bad until they take them out. But the pain is very brief. She's doing well now and has some biceps movement even against gravity. We are now waiting for her triceps to kick in. They said by June she should have some activity there. Good luck to you. Sue

The operation was painless. I mean after the op. They gave me a morphine drip for a few days that I played around with out of boredom but I had no pain. But I have never had nerve pain and that might make a difference. I was in hospital 6 days, they tried to get rid of me a little earlier but as I live alone and still had the drains in they let me stay. The drains I hardly noticed, just a pain to drag around when you are going to the loo. The by far worst part was the cast as it was an aeroplane cast (yours will be different for biceps) and it was a hellish 6 weeks, just basically because it was so uncomfortable and annoying. The only time I had real pain was when they took the cast off, the muscle was stiff but that improved greatly over the following few days.

An Irish surgeon did my surgery. It was his first time doing it on an adult but beggars can't be choosers.

SRHYKERD,
Did your daughter have a cast or splint after the surgery, and for how long? How long before she could start to exercise the arm again? Did you have the drains and skin graft I hear so much about? I see she can move against gravity, do you know how long after the surgery this happened? Just asking as this looks like gracillis transfer is what Dustin may have.
Thanks, Sue

Sue,
My daughter had a cast that covered 3/4 of her arm that held it pretty much at a 90 degree angle and she also had an abductor immobilizer with that for 6 weeks. After the 6 weeks were up, she had a splint on without the immobilizer, but she had to make sure her arm never fell down by her side. They never wanted it to go less than the 30 degree mark because the muscle stays stronger if it doesn't go completely down. As far as any ROM, she was limited to flexing her arm at her elbow and working her fingers. She's only allowed to abduct her shoulder about 70 degrees because of the nerve transfers from her chest. So exercise was very limited and that happened after she was out of the cast. As far as the drains go, she had 3 JP drains right after surgery which were all removed before she was discharged from the hospital. 2 were in her leg and 1 was in her arm. An area of skin from her right thigh, where they took the gracilis muscle, was also transferred to her shoulder so they could monitor the blood flow to the arm. In fact she still has it. They don't usually remove that before a year after surgery. The sutures around that were the only ones they had to remove after surgery. She was initially concerned about hair growth on this flap since it came from her thigh, but her hair is light and not noticable. She started moving her arm about 5-6 months after surgery. It just started out as a flexing of her biceps and then gradually she could move it horizontally on a table (that happened at about 7 months). It wasn't until about 8 months after surgery that she could flex her arm against gravity. They say that next her triceps will kick in and she will be able to extend her arm. Right now it just falls down when she doesn't hold it up. Her hand movement is very rudamentary, but it's still there and she can control it. Each step is very exciting but it does take a long time and lots of patience. Good Luck to you and Dustin! Another Sue (Melanie,s mom)

Sue,
Thanks for all the information. We will be returning to Mayo on the 6th of March for an evaluation. Also seeing an ortho surgeon this time. They suggested either a tricep tranfer or gracillis. Dustin is thinking of the gracillis as he doesn't want to lose tricep. Hoping he can get the arm to bend up. He has total hand function but it's mostly useless without being able to move the arm.
Sue

Dr. Sanger is considering several surgical techniques to allow me some bicep movement. One is taking ulnar muscle and attaching the muscle to the forearm muscle and underneath the bicep to the humorous bone. The other technique is to take my gracilias muscle and attach the muscle to the shoulder and bicep muscles. The pain from the muscle/tendon transfer surgery is not what I am concerned with, but the results! I cherish my legs, and am concerned about scarring and the functioning of the leg/s after taking the gracilias muscle. Can anybody share their results from a muscle/tendon transfer? Thanks