Various Functioning Free Muscle Transfer For Restoration of Hand Function

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Journal of the Korean Society for Surgery of the Hand 2002;7(2):130-138.
Published online June 1, 2002.

Sang-Hyun Woo, Jung-Hyun Seul

다양한 기능성 유리 근 피판 전이를 이용한 수부 기능의 재건

우상현, 설정현

Abstract

In extensive injuries of the flexor muscles of the forearm or thenar muscles, we performed 12 cases of functioning muscle transfers from various donor sites. There were 10 cases of elective operations and 2 cases of immediate reconstruction for the segmental defect of the flexor muscles in forearm. For reconstruction of flexor function, 7 gracilis muscles and 4 latissimus dorsi muscles were used. And, an abductor hallucis muscle with medial plantar flap was transferred for reconstruction of opposition of the thumb and resurfacing of the thenar defect. Despite all transferred muscles survived, there was one case of functional failure due to persistent chronic osteomyelitis of the radius. Among 12 cases, we achieved 10 cases (84%) of functional success, which means muscle power to function against resistance. On average, total active motion of fingers were 115 degrees, and grasping and pinch strength were 3.5kg and 1.9 kg, which was 38% and 35% of the opposite normal side, respectively. Free functioning muscle transfer with motor innervation is the only method to regain hand function in case of extensive injury due to amputation or electrical burn. For achieving the best functional outcome, good range of passive joint motion and appropriate soft tissue coverage on the distal forearm are prerequisites. All necrosed and fibrosed muscles and scar tissues have to be excised with neurolysis of median and ulnar nerve. Optimal tension balance of transferred muscle should be precisely reestablished intraoperatively. And, postoperative exercise program to build muscle strength should be followed for at least one year.

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