Vaile John R, Tipps John A, Struble Sarah L, Patel Niki K, Kota Anchith, Mendenhall Shaun D
Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
J Hand Microsurg. 2025 Mar 6;17(3):100242. doi: 10.1016/j.jham.2025.100242. eCollection 2025 May.
Free functional muscle transfer (FFMT) is a versatile surgical option for restoring function in cases of acute trauma, ischemic contracture, or tumor resection. FFMT is often considered a last resort due to procedural complexity and lack of microsurgical availability. While FFMT is well described for brachial plexus injury and facial trauma, its application in Volkmann's ischemic contracture (VIC) is underexplored, with variable operative timelines and postoperative outcomes.
Following PRISMA-ScR guidelines, PubMed and Ovid electronic databases were searched using the following keywords: "Volkmann," "compartment syndrome," "muscle transfer," "muscle transplantation," and/or "reconstruction." Studies were imported into Covidence, and screening was performed by two independent reviewers. Patient characteristics, surgery information, and postoperative clinical data were extracted.
The scoping review included 21 studies. In total, 163 FFMTs for VIC were performed, most commonly using the gracilis muscle (64.4 %) for finger flexion deficits (91.4 %). Nerve selection was variably reported, with the anterior interosseus nerve (AIN) used most frequently. Grip strength, range of motion, and total active motion were the most frequently utilized outcome measures. FFMT success rates were high (96 %), and 34.6 % of all-comers experienced tendon or muscle adhesions that required subsequent tenolysis or adhesiolysis. Several studies recommended early exploration within 3 weeks, and FFMT within 6 months of the initial injury; however, successful FFMT cases were reported up to 20 years post-injury.
FFMT remains a viable option for VIC treatment, with a 96 % success rate. There is a relatively high incidence of tendon or muscle adhesions (34.6 %) that require secondary procedures.
游离功能性肌肉移植（FFMT）是一种用于修复急性创伤、缺血性挛缩或肿瘤切除后功能的通用手术选择。由于手术操作复杂且缺乏显微外科技术支持，FFMT常被视为最后的手段。虽然FFMT在臂丛神经损伤和面部创伤方面已有详细描述，但其在Volkmann缺血性挛缩（VIC）中的应用尚未得到充分探索，手术时间和术后结果存在差异。
按照PRISMA-ScR指南，使用以下关键词在PubMed和Ovid电子数据库中进行检索：“Volkmann”、“骨筋膜室综合征”、“肌肉移植”、“肌肉移植术”和/或“重建”。研究被导入Covidence，并由两名独立评审员进行筛选。提取患者特征、手术信息和术后临床数据。
范围综述纳入了21项研究。总共进行了163例针对VIC的FFMT，最常用的是股薄肌（64.4%）来治疗手指屈曲功能障碍（91.4%）。神经选择的报告各不相同，最常使用的是骨间前神经（AIN）。握力、活动范围和总主动活动是最常用的结局指标。FFMT成功率较高（96%），所有患者中有34.6%出现肌腱或肌肉粘连，需要随后进行肌腱松解术或粘连松解术。几项研究建议在3周内尽早进行探查，并在初次受伤后6个月内进行FFMT；然而，受伤后长达20年也有成功的FFMT病例报告。
FFMT仍然是治疗VIC的可行选择，成功率为96%。肌腱或肌肉粘连的发生率相对较高（34.6%），需要进行二次手术。
