The proposed procedure would employ NTX-001 as a free functional muscle transfer to the upper

extremity. This procedure is meant to restore the function of one or two joints in the upper

extremity by bringing the gracilis muscle from the leg with its associated obturator nerve

and its vascular pedicle. Most commonly, and in this case, as well, elbow flexion is the main

function that is targeted for improvement. This is for a brachial plexus injury, and

therefore we would be using an extraplexal nerve as a donor nerve to reinnervate the gracilis

muscle. Most commonly, this is the spinal accessory nerve. The only proposed direct

tension-free coaptation that would be subject to NTX-001 is the spinal accessory nerve to the

obturator nerve. The benefit of this would be immediate reinnervation of the gracilis in the

arm without a period of muscle atrophy that traditionally occurs with this operation.

Usually, the first signs of any muscle contraction occur around 6 months when the patient

tries to flex their elbow. With NTX-001, this may be significantly expedited with early

return of function and result in greater muscle strength due to the prevention of muscle

atrophy.