A review of free muscle grafting.

Free grafting of small muscles is followed by graft necrosis and subsequent reconstitution of graft architecture by the process of muscle regeneration. Large muscles turn instead to scar. Revascularization and reinnervation can occur from the adjacent muscle bed, but reinnervation is more effective when a nerve is implanted or neurorrhaphy is performed. The appearance of a variable amount of connective tissue in a grafted muscle may degrade function. The necessity of "predenervation" remains in question. As we obtain greater experience in the laboratory and in clinical utilization, it is hoped that free muscle grafting will become a more predictable reconstructive procedure.