Functioning free muscle transplantation.

Functioning free muscle transplantation to the extremity is technically feasible based on microvascular anastomosis and fascicular nerve repair. Success depends on precise operative technique and a vigorous program of postoperative therapy. The most important operative details are the nerve repair and placement of the muscle at optimum tension. The forearm should be considered for muscle transplantation if there is a lack of finger flexion as a result of the loss of flexor musculature and if simpler techniques of tendon transfer are unavailable. The long-term results of 12 muscle transplantations to the forearm are presented. Eleven muscles survived completely and provided useful function, Nine provided a full range of finger motion. The maximum grip strength obtained with this procedure was 50% of normal grip strength.