Abstract
Intercostal nerve donors for traumatic brachial plexus injury reconstruction have been used to neurotize native muscles or free-functioning muscle transfers, with inconsistent outcomes reported. The aim was to record a substantial series, evaluate functional outcomes, and identify prognostic factors. We present a single-surgeon case series of 21 consecutive patients who underwent 21 transfer procedures to either native muscles or free-functioning muscles to reconstruct elbow extension over a 9-year period. Outcome parameters included target muscle power grade and timing of recovery. A Medical Research Council power grade ≥ M4 was achieved in 17 reconstructions. The free-functioning muscle group had significantly higher success rate and reached their best power grade 14 months earlier. Free-functioning muscle reconstruction with intercostal nerve transfer is a more complex procedure but has quicker functional recovery and greater reliability in achieving grade M4.