Traumatic crushing injuries of the muscle compartments will occasionally cause major
muscle or muscle-group loss with concomitant irreparable nerve injuries. Those cases
with or without the availability of local muscle transfers form another indication
for functioning free muscle transplantation (FFMT). The authors report their experience
with 20 FFMTs in 14 patients with severe muscle loss from 1986 to 1996. They were
selected because all their major muscle loss was primarily due to muscle avulsion,
avascularity, and necrosis, but not secondarily due to nerve injury or ischemic injury.
The motor nerves innervating these muscles were either disrupted after muscle debridement
or avulsed from the neuromuscular junction concomitantly. The initial injury in this
series was so severe that in many cases amputation was advised. Fractures were present
in almost half the cases (6/14). Half the cases required revascularization due to
rupture of major vessels (7/14), and the need for free-tissue transfer for soft-tissue
coverage was demonstrated in over two-thirds (8/14). All FFMTs were innervated by
the motor nerve which originally innervated the lost major muscle(s), and to replace
palmar arm compartment (elbow flexors, 6 cases), palmar forearm compartment (finger
flexors, 6 cases), and dorsal forearm compartment (finger extensors, 8 cases). Postoperative
follow-up ranged from 3 to 12.5 years (average: 8.3 years). The success rate, i.e.,
achieving M4 muscle strength, was nearly 90 percent (18 of 20 FFMTs). Two cases with
sub-optimal results were performed in the acute stage for the purpose of soft-tissue
coverage and functional results. These reconstructions make the originally compromised
limb useful for most activities of daily living. This type of injury should be recognized
as providing a good prognosis after application of the FFMT, and arbitrary amputation
should be avoided.
KEYWORDS
Traumatic major muscle loss - upper extremity - functioning free muscle transplantation
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David Chwei-Chin ChuangM.D.
Department of Plastic and Reconstructive Surgery
199 Tung Hwa North Road
Taipei, Taiwan, 105
