Journal of hand and microsurgery · 2026
Free functional muscle transfer in children: A long-term case series from a single microsurgical unit.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
El-Gammal Tarek Abdalla, El-Sayed Amr, Kotb Mohamed Mostafa, Saleh Waleed Riad, Ragheb Yasser Farouk, El-Gammal Yousif Tarek, Refai Omar Ahmed
Аннотация
BACKGROUND: Restoration of active motion in children with upper-limb paralysis or muscle loss remains challenging. Free functional muscle transfer (FFMT) is a reconstructive option when local muscle donors are unavailable, but uncertainties persist regarding optimal timing, donor nerve selection, and long-term effects of growth and secondary deformities. This study reports a single-institution experience addressing these issues.
METHODS: A retrospective review was conducted of 35 children (<18 years) who underwent upper-limb FFMT with a minimum follow-up of 24 months. All reconstructions used the gracilis muscle to restore finger flexion, elbow flexion, elbow extension, or combined functions. Donor nerves included the anterior interosseous nerve (AIN) with or without median nerve fascicles, intercostal nerves, spinal accessory nerve, and phrenic nerve. Outcomes included time to muscle activation, range of motion, Medical Research Council (MRC) strength, secondary procedures, complications, bimanual use, and patient or caregiver-reported satisfaction. Pre- and postoperative outcomes were compared using paired and groupwise statistical tests.
RESULTS: Mean age at surgery was 7.6 years, with a mean follow-up of 68 months (range, 24-166 months). Flap survival was 100%. Initial muscle activation occurred at a mean of 4.1 months. Significant improvements in motion and strength were observed across all functions (p < 0.001). MRC grade ≥4 strength was achieved in 80.0% of elbow-flexion reconstructions and 78.3% of finger-flexion reconstructions. Finger-flexion reconstructions demonstrated higher bimanual use and more consistent recovery than elbow-flexion reconstructions. In construct-level analysis, single-function transfers showed clearly superior finger-flexion outcomes, whereas elbow-flexion results differed by endpoint: single-function transfers achieved greater ROM, while all dual-function elbow-flexion transfers reached MRC grade ≥4 in this small subgroup. Secondary procedures were required in 51.4% of patients. Overall satisfaction was reported by 71.4% and correlated more strongly with final strength and completion of reconstruction than with range of motion.
CONCLUSIONS: Gracilis FFMT provides durable restoration of active motion and strength in children. Outcomes are influenced by indication and reconstructed function rather than donor nerve selection alone. Strength recovery and functional integration are primary determinants of bimanual use and satisfaction. Findings support the use of FFMT as part of a staged reconstructive strategy in pediatric patients.
METHODS: A retrospective review was conducted of 35 children (<18 years) who underwent upper-limb FFMT with a minimum follow-up of 24 months. All reconstructions used the gracilis muscle to restore finger flexion, elbow flexion, elbow extension, or combined functions. Donor nerves included the anterior interosseous nerve (AIN) with or without median nerve fascicles, intercostal nerves, spinal accessory nerve, and phrenic nerve. Outcomes included time to muscle activation, range of motion, Medical Research Council (MRC) strength, secondary procedures, complications, bimanual use, and patient or caregiver-reported satisfaction. Pre- and postoperative outcomes were compared using paired and groupwise statistical tests.
RESULTS: Mean age at surgery was 7.6 years, with a mean follow-up of 68 months (range, 24-166 months). Flap survival was 100%. Initial muscle activation occurred at a mean of 4.1 months. Significant improvements in motion and strength were observed across all functions (p < 0.001). MRC grade ≥4 strength was achieved in 80.0% of elbow-flexion reconstructions and 78.3% of finger-flexion reconstructions. Finger-flexion reconstructions demonstrated higher bimanual use and more consistent recovery than elbow-flexion reconstructions. In construct-level analysis, single-function transfers showed clearly superior finger-flexion outcomes, whereas elbow-flexion results differed by endpoint: single-function transfers achieved greater ROM, while all dual-function elbow-flexion transfers reached MRC grade ≥4 in this small subgroup. Secondary procedures were required in 51.4% of patients. Overall satisfaction was reported by 71.4% and correlated more strongly with final strength and completion of reconstruction than with range of motion.
CONCLUSIONS: Gracilis FFMT provides durable restoration of active motion and strength in children. Outcomes are influenced by indication and reconstructed function rather than donor nerve selection alone. Strength recovery and functional integration are primary determinants of bimanual use and satisfaction. Findings support the use of FFMT as part of a staged reconstructive strategy in pediatric patients.