Free muscle transplantation by microsurgical technique to treat severe Volkmann's contracture.

In a free muscle transfer, great care must be taken in selecting the muscle to be grafted. We have found the pectoralis major to be a good donor muscle. Although most muscles are not nourished by a single artery and a few veins, the vessels which enter the pectoralis major muscle with the nerves are the main nutrient vessels, and these vessels alone can adequately nourish this muscle. Neurorrhaphy should be performed at a site as close as possible to the muscle. Good indications for free muscle transfer are cases in which a flexor muscle has become necrotic, while the extensor muscle is viable--for example, if the flexor muscle has sustained traumatic crushing injury or if there is a Volkmann's contracture.