Six children between 7-16 years of age presented with flail shoulder and elbow caused by poliomyelitis. Shoulder fusion was followed by free functioning gracilis transplantation to replace the atrophied biceps muscle. The transplanted muscle was reinnervated by either the spinal accessory or phrenic nerve. Follow up averaged 44 months (range 56-23 months). All cases developed, at least, grade three power of elbow flexion and were able to place their hands to the mouth. Five out of six cases were able to flex elbow against resistance. One case required tension readjustment and elbow flexion contracture of 45odeveloped in another case. On the average, the transplanted gracilis started to contract 3 months after transplantation, muscle power reached grade two at 5- 6 months and grade three at 9-12 months. Muscles supplied by the spinal accessory nerve were earlier to contract and ultimately attained more power than those supplied by the phrenic nerve, probably because of easier rehabilitation. Shoulder fusion and free functioning gracilis transplantation for biceps replacement provide a solution for restoration of function in children with flail shoulder and elbow, caused by poliomyelitis. . The procedure can be useful in other neuromuscular conditions, as in late presenting Erb's palsy, especially when no other muscles are available for local transfer.