Chapter 21 - Surgical and Therapeutic Management of Volkmann’s Ischemic Contracture and Free Functional Muscle Transfer

Abstract

Volkmann's ischemic contracture is the outcome of prolonged muscle and nerve ischemia resulting most commonly from acute compartment syndrome. Surgical management involves flexor origin slide for mild-to-moderate contracture and free functional muscle transfer for severe contracture. Therapeutic management is directed toward maintenance of passive joint motion, preservation, and strengthening of remaining muscle function, and correction of contracture through static progressive splinting. Deficits in the upper extremity that are not amenable to tendon, nerve, or rotational muscle transfers may benefit from free functional muscle transfer. Common indications are Volkmann ischemic contracture, late reconstruction of brachial plexus injuries, traumatic muscle loss, oncologic resection, and congenital absence of motor function. Therapeutic management is directed toward specific phases of rehabilitation: nerve reinnervation phase, muscle and nerve activation phase, and muscle strength and function phase.