Reconstruction of elbow flexion by transposition of pedicled long head of triceps brachii muscle.

A new technique of restored flexion in the elbow joint in an inveterate injury of the brachial plexus is described. The insertion of the long head of the triceps brachii muscle was transferred with an intact nervous and vascular supply to the anterior brachial region and sutured above the radial tuberosity with the insertion tendon of the biceps brachii muscle. The muscle strength three months after surgery according to the muscle test was 4-. Flexion in the elbow joint was possible up to 85 degrees. Extension in the elbow joint was preserved, the muscle strength was 3. Anatomical investigation revealed that the mean length of the nerve of the long head of the triceps was 5.5 cm, the number of terminal branches was 3-4, 70% of the vascular supply was from the brachial artery, the length of the vascular bundle was 3.6 cm. In 33% there was an additional neurovascular hilus which was 2-3 cm distally from the main hilus. The investigation confirms that the neurovascular pedicle of the long head of the triceps brachii muscle is sufficiently mobile and damage by traction during transposition of the insertion tendon is therefore not likely. Transfer of the long head of the triceps brachii muscle in inveterate injuries of the brachial plexus is a suitable alternative for reconstruction of nerves or transfer of other muscles to restore flexion in the elbow joint.