Roongsak Limthongthang

1 Introduction Free functional muscle transfer (FFMT) using the gracilis muscle is a standard treatment for late presentation of brachial plexus injuries or failed primary nerve transfer surgeries. However, in patients with multiple unfavorable risk factors that increase the likelihood of primary nerve transfer failure, FFMT can be utilized as an initial intervention to improve function of the disabled limb (Neti et al. 2022).

Introduction Global brachial plexus injuries or lower root avulsions have a devastating impact on upper extremity function and quality of life of affected patients (Carlstedt, 2008; Franzblau and Chung, 2015), who are predominantly young male adults (Seddighi et al., 2016). Due to the loss of neural connectivity of the hand and arm, also referred to as “inner amputation,” both muscle function and sensibility of the affected skin are permanently impaired.