Functional Free Muscle Transfer for Upper Extremity Reconstruction

Abstract

Functional losses in the upper extremity that cannot be restored by nerve or tendon transfer present a treatment dilemma to the reconstructive surgeon. Common indications for functional free muscle transfer include late reconstruction of brachial plexus injuries, traumatic muscle loss, Volkmann ischemic contracture, loss resulting from oncologic resection, and congenital absence of motor function as seen in arthrogryposis. This article reviews the authors' experience in upper extremity reconstruction using functional free muscle transfer. The indications and technique for functional free muscle transfer in the upper extremity are reviewed. Surgical details for sites of reconstruction and the nuances of harvesting the main donor muscles are presented. Specific cases and outcome reviews for several series of functional free muscle transfers are presented. Functional free muscle transfer is the best and final option for restoring function in an otherwise nonreconstructible limb.