Anterior Deltoid to Biceps Transfer for Restoration of Elbow Flexion

Major injuries to the infraclavicular or axillary region requiring axillary artery repair or reconstruction, a replantation carried out at the proximal third of the arm, or an infraclavicular brachial plexus palsy with failed nerve reconstruction pose a challenge to a reconstructive surgeon with only the shoulder remaining functional. We observed that patients with these injuries exhibited a 'trick' movement causing elbow flexion by abducting the shoulder beyond 90 degrees, which led us to use the anterior fibers of the deltoid extended with fascia lata graft as a donor to restore elbow flexion in them. 11 patients, including 9 males and 2 females, underwent the transfer. Patients were followed up at 1, 3, 6 months, and 1 year; functional outcomes were assessed at 1 year. The mean follow-up period was 27 months (4 to 88 mo). At 3 months of follow-up, all patients demonstrated active elbow flexion by initiating shoulder abduction. Nine of these patients with more than 1 year of follow-up demonstrated MRC grade 3 elbow flexion, with motion up to 120 degrees, independent of shoulder motion. Anterior deltoid transfer is a useful option for restoring elbow flexion when standard options are unavailable in selected cases and deserves a place in the reconstructive surgeon's armamentarium.