This 5 year old boy from direct referral by a charity clinic. He had almost no use of either upper extremity due to a rare congenital disorder called arthrogryposis congenita multiplex. His particular form of the disorder affected only his arms in that there were no motor neurons (nerves) going to his arms, hence they never developed any motor function. He uses his legs to bring his hands to his mouth for feeding and is very dependant on his mother. Dr. Roger Khouri and I performed a gracilis muscle transfer from the leg to replace the bicep muscle function in his arm and allow him to flex his elbow. The muscle was innervated by a nerve graft from the lower leg (sural nerve) that went from the intercostal (ribcage breathing muscles) to the newly transferred muscle. This free functional muscle transfer was performed in a 14 hour surgery that is only now showing the beneficial results. He remains in weekly therapy to train his new found bicep muscle and will hopefully be able to feed himself using this reconstruction.