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a b
Figure 2: (a) Preoperative photograph of a 20‑year‑old male who presented
16 months after injury above the right clavicle; (b) postoperative a
photograph showing 100° of active abduction of the right shoulder b
Figure 3: (a) Preoperative photograph of a 17‑year‑old male who had
a failed nerve transfer on the right side; (b) postoperative photograph
5.63° (range: 0°‑15°) to 55.25° (range: 40°‑90°), the range of showing 90° of active abduction of the right shoulder
improvement was from 25° to 80°.

Muscle power plays a pivotal role in the day to day Table 1: Results of modified trapezius transfer (32 patients)
activities of a patient. Medical Research Council 4 was Movements of Preoperative Range Postoperative Range
encouragingly found in 19 patients (59.38%) after trapezius shoulder
transfer [Table 2]. Abduction (°) 7.5 0-30 85 45-140

The patients’ assessment of the results was excellent in Forward flexion (°) 5.63 0-15 55.25 40-90
6 cases (18.75%) when active abduction was more than Mean follow‑up 8.25 months (6.5‑12 months)
120°, good in 18 cases (56.25%) when active abduction
was 90°‑120°, fair in 5 cases (15.63%) when active Table 2: Muscle power after transfer (MRC scale)
abduction was 60°‑90°, and poor in 3 cases (9.37%) when
active abduction was less than 60° [Table 3]. MRC grade Number of patients (%)
4 19 (59.38)
Complications 2-3 10 (31.25)
Two patients were found to have a loose cancellous screw 0-1 3 (9.37)
with abduction limited to 35° and 45°, respectively. One MRC: Medical Research Council
patient required eventual removal of the loose screw. Flap
necrosis at the suture line was observed in one patient
and healed with conservative management. Table 3: Satisfaction level of patients and clinical correlation
Subjective opinion Number of Range of abduction which
DISCUSSION of patients patients (%) satisfied the patients (°)
Excellent 6 (18.75) > 120
Secondary surgery in brachial plexus palsy is often Good 18 (56.25) 90-120
required for the restoration of shoulder movement Fair 5 (15.63) 60-90
[8]
and for the restoration of both analgesia and function. Poor 3 (9.37) < 60
Because the shoulder joint is a large and proximal
joint, it is essential for adequate function of distal of the scapula and acromion, and in mobilization of
[4]
joints of the upper limb. Local pedicled muscle transfer the upper and middle trapezius muscle with the clavicle,
and glenohumeral arthrodesis remain the mainstay of acromion and scapular spine. The latter two procedures
[5]
treatment. With the recent advances in microsurgery, free involve extensive, deep and difficult dissection with
muscle transfer is also possible. [2]
sacrifice of a significant amount of muscle and bone.
Arthrodesis of the shoulder has traditionally been an In the technique presented in this paper, only the upper
option in patients with instability secondary to a brachial
plexus lesion. However, the surgical technique is difficult, fibers with the lateral clavicle were dissected with good
lengthy, and there is no consensus regarding the ideal results.
position for glenohumeral fixation. In addition, the rates Using Saha’s technique, Aziz et al. noted that there was
[13]
of pseudoarthrosis, fracture, residual pain, repositioning a gain in the abduction of 45.4° following transfer of the
of the limb, and irreversibility of the procedure are acromioclavicular segment. Using the same procedure,
[9]
significant limiting factors. However, failure after Kotwal et al. achieved a gain of 60° of abduction,
[10]
[14]
muscle transfer may be salvaged by shoulder fusion. although the mean level of abduction attained was not
[11]
Microsurgery is more cumbersome, has a long learning mentioned. Conversely, Ruhmann et al. achieved a mean
[15]
curve, and tension adjustment is not reliable. abduction of only 39° with a mean forward flexion of 44°.
[10]
The trapezius muscle has previously been used as a Severo et al. obtained more encouraging results with
donor muscle only with periosteum, which results in a mean postoperative abduction of 75.8° and flexion of
[12]
[16]
gradual stretching of the muscle and progressive loss of 77°. On the contrary, Ragab and El‑Sayaed achieved only
abduction, in trapezius muscle transfer with the spine 39° of abduction and 32° of flexion. Clearly, the functional
348 Plast Aesthet Res || Vol 2 || Issue 6 || Nov 12, 2015