Technical considerations in two-stage functioning free muscle transplantation reconstruction of both flexor and extensor functions of the forearm.

We report on two patients with severe injuries of the forearm who were reconstructed using functioning free muscle transplantation (FFMT) for individual replacement of flexor and extensor function. In both cases a two-stage procedure was performed: The extensor reconstruction preceded the flexor reconstruction by 4-6 months. The extensor digitorum communis and flexor digitorum profundus were successfully reconstructed in both cases using bilateral gracilis FFMT. In one case the flexor pollicis longus and extensor pollicis longus were also reconstructed using the adductor longus in addition to the gracilis. Clinical follow-up was a minimum of 2 years. Both patients achieved wrist control, excellent finger flexion, and metacarpophalangeal joint extension. One patient also had good interphalangeal finger extension, but the other developed a persistent claw deformity due to the lack of recovery of ulnar nerve function. Performing the extensor reconstruction prior to the flexor reconstruction theoretically allows a more rapid return of function and a shorter rehabilitation period than using the converse sequence.