Pulley Reconstruction for Bowstringing After Gracilis Free Functioning Muscle Transfer for Elbow Flexion in Adult Traumatic Brachial Plexus Injury

The gracilis free functioning muscle transfer is an established procedure for reconstructing elbow, wrist, and hand function in adult traumatic brachial plexus injury patients. Elbow flexion or distal wrist or hand function can be compromised by gracilis bowstringing in up to 17.8% of patients. Two techniques for pulley reconstruction to correct bowstringing and improve the function of the gracilis transfer are described.