3.1 NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 10 sources, which was discussed by the committee. The evidence included 2 systematic reviews, 4 non‑randomised comparative studies and 4 case series. It is presented in table 2 of the interventional procedures overview. Other relevant literature is in the appendix of the overview.
3.3 The professional experts and the committee considered the key safety outcomes to be: pain, bleeding, infection and graft failure.
3.4 Patient commentary was sought but none was received.
3.5 The committee noted that this procedure can be done as a single or double free-functioning gracilis transfer. The evidence suggests a double transfer may be more effective than a single transfer.
3.6 The committee noted that postoperative physiotherapy is essential for functional recovery and relearning neurological muscle control. Long-term supervision from physiotherapists is needed and the patient must be completely engaged with their therapy.
3.7 The committee was informed that after the procedure it takes about 4 months for nerve reconnection and up to 1 year for muscle movement.
3.8 The committee noted that severe brachial plexus injury can have considerable adverse effects on a person's ability to carry out daily activities and their quality of life.
3.9 The committee noted that the procedure can be done as a part of primary treatment for total brachial plexus paralysis, or as a salvage treatment when reinnervation of existing muscles has failed to restore function in the upper limb.