Importance of early passive mobilization following double free gracilis muscle transfer

Background: The tendinous portion of the transferred muscle following double free gracilis muscle transfer for reconstruction of prehensile function in complete paralysis of the brachial plexus has a tendency to adhere to the surrounding bed and thus impede active finger motion despite powerful contraction of the muscle per se. The purpose of this study was to evaluate the effectiveness of early postoperative passive mobilization of the tendon to prevent its adhesion and the need for tenolysis. Methods: Of 34 patients who under-went double free gracilis muscle transfer technique, the initial 19 patients (group 1) underwent the conventional postoperative management consisting of 6 weeks of immobilization, and the following 15 patients (group 2) had early passive mobilization. Postoperative active range of motion of elbow and finger joints and the incidence of tenolysis were reviewed. Results: Early passive mobilization technique in group 2 negated the need for tenolysis of the transferred muscle, whereas 10 of 38 transferred muscles in group 1 required tenolysis to improve finger motion. Before tenolysis, there was a significant difference of total active finger motion between group I and group 2, although there was no significant difference in the total active finger motion between group I and group 2 after tenolysis. Conclusion: Early passive mobilization in the postoperative period, consisting of tendon compression at the elbow and assisted resistance exercises of finger and wrist joints, can prevent postoperative adhesion and improve tendon excursion and motion of the free transferred muscle.