Temporary innervation of a primary coverage muscle: a new technique to optimize function in a subsequent functional microvascular muscle transplant.

The author describes the simple technique of innervating the coverage muscle in the staged reconstruction of an upper-extremity crush-avulsion injury with a functional microvascular muscle transplant (FMMT). The thoracodorsal nerve was repaired to the mixed motor-sensory radial nerve above the elbow. Contraction of the latissimus muscle at 8 months after nerve repair signaled the adequacy of the 10-cm thoracodorsal nerve graft as a target motor nerve for the eventual FMMT. Excursion of the latissimus muscle created a septo-alveolar plane similar to the plane between two healthy muscles into which the FMMT could be placed. The author also discusses the potential advantages of early thoracodorsal nerve repair for successful nerve regeneration. This simple technique helped overcome the potential limitations to functional muscle transplantation in the severely traumatized upper extremity, and deserves applied study.