Viability of the Skin Paddle Does Not Predict the Functional Outcome in Free Muscle Transfers with a Second Ischemic Event: A Report of Three Cases

Abstract

Conventional skin flap monitoring is one of the widely used methods to assess postoperative circulation in innervated free muscle transfer (IFMT). However, following reexploration for vascular compromise and reestablishing circulation, functional recovery of the muscle despite surviving skin flap is not clear. The purpose of this article is to report three such cases and determine the reliability of viable skin flap in an IFMT with a second ischemic event. Long-term functional results were assessed in terms of reinnervation time, elbow range of motion, strength of elbow flexion, finger function in terms of total active motion, and power lifting with hook grip. These IFMTs developed complete or partial necrosis of the muscle and could not obtain satisfactory function. The conventional monitoring of the skin flap did not promptly reflect vascularity of IFMT, and a surviving skin flap after reexploration for compromised vascularity does not guarantee complete survival of the muscle. There is a need for earlier and rapid detection of vascular compromise in IFMTs.