Functional restoration in the upper extremity using free muscle transplantation.

Since 1973, fourteen free muscle transfers for functional upper limb reconstruction have been performed in twelve patients at the Ralph K. Davies Medical Center in San Francisco. All of the patients in this series had lost finger flexion, extension, and/or thumb opposition and were not candidates for simpler methods of reconstruction because of weakness or traumatic loss of balancing musculature. The 12 patients have been followed for one to 9 years. All muscles were successfully transferred without flap loss. Evaluation of the EMG data has shown evidence of reinnervation beginning at approximately two months with fibrillation potentials decreasing and recruitment of increasing numbers of motor units over two to three years. Eleven of the 14 muscles attained movement against resistance; two had movement against gravity and one regained only a flicker of motion. In our experience, the use of free muscle transplantation to restore function is not only technically feasible, but moreover, has resulted in a relatively high degree of patient satisfaction.