Penn Center for Peripheral Nerve Disorders

The Penn Difference

The most recent innovation in Penn's Center for Peripheral Nerve Disorders is the performance of gracilis free functional muscle transfers for restoration of movement in paralyzed upper extremities, including the hand and arm.

Gracilis free functional transfers help patients who have suffered devastating avulsion injuries, in which a ligament or tendon is pulled away from the bone at the brachial plexus. The brachial plexus is a network of nerves that originates from the spinal cord and controls muscle movements and sensation in the shoulder, arm and hand.

If no direct nerve reconstruction is possible, the multidisciplinary team from Penn Medicine's departments of neurosurgery, orthopaedics and plastic surgery perform the procedure in which the gracilis muscle is transplanted from the patient's inner thigh up to the arm to replace the paralyzed biceps muscle.

Using microsurgical techniques, the gracilis muscle's blood supply is connected to local vessels in the chest and a donor nerve from the patient's neck or chest is attached to the gracilis muscle's nerve supply. In approximately 70 percent of cases, useful elbow flexion is restored to the previously paralyzed limb.