Free-Functioning Muscle Transfers After Major Upper Limb Replantation.

PURPOSE: Major upper limb replantation surgery is a complex undertaking that often requires secondary reconstructive procedures to improve function. The loss of critical functional muscle groups in the forearm was once considered a relative contraindication for replantation. The advent of free-functioning muscle transfers (FFMTs) has expanded the boundaries for replantation. In this study, we seeked to review the indications, surgical considerations, and outcomes of the use of FFMTs after major upper limb replantation.

METHODS

In this retrospective study, we included patients who underwent replantation surgery for amputations at or proximal to the forearm and subsequent FFMTs for reconstruction of motor function.

RESULTS

A total of 16 patients received 20 FFMTs between the period of 1998 and 2022. These were all used to reconstruct finger flexion or finger extension or both. All patients underwent secondary procedures to further augment functional outcomes after FFMT surgery.

CONCLUSIONS

Free-functioning muscle transfers serve as a useful reconstructive tool for restoration of motor function following major upper limb replantation.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.