Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2007 Jun;119(7):2118-2126.
doi: 10.1097/01.prs.0000260595.85557.41.

Free functioning muscle transfer for lower extremity posttraumatic composite structure and functional defect

Chih-Hung Lin  1 , Yu-Te Lin, Jiun-Ting Yeh, Chien-Tzung Chen
Affiliations

Free functioning muscle transfer for lower extremity posttraumatic composite structure and functional defect

Chih-Hung Lin et al. Plast Reconstr Surg. 2007 Jun.

Abstract

Background: Traumatized lower extremities may present not only composite soft-tissue defects but also flexor and/or extensor loss. Free functioning muscle transfer can provide composite structural and functional restoration.

Methods: From 1996 to 2004, 19 patients with lower extremity injuries whose lesions exhibited composite soft-tissue damage, with or without bone defects, and certain accompanying functional disabilities were allocated to study groups on the basis of impression, as follows: group I, open fracture IIIB (n = 10); group II, neglected compartment syndromes [open IIIB (n = 4) and open IIIC (n = 1)]; and group III, crush injuries (n = 4). Free flap resurfacing was indicated for these lesions. Fifteen patients underwent free functioning muscle transfer; source muscles were the rectus femoris (n = 3), rectus femoris with anterolateral thigh flap (n = 5), and gracilis (for ankle dorsiflexion) (n = 7). Two patients underwent composite rectus femoris and vascular iliac crest for ankle dorsiflexion and segmental tibial defect reconstruction. Two received rectus femoris muscle and anterolateral thigh flaps for posterior compartment defect and quadriceps defect reconstruction, individually.

Results: Two patients required reexploration; salvage was successful in only one, with below-knee amputation necessary in the other. Skin grafts were needed for partial skin paddle necrosis (n = 3) or remaining skin defect (n = 2). Functioning muscle reinnervation failed in four cases, with one individual undergoing ankle fusion, two people electing ambulation with stiff ankles, and one person using an orthosis. In the sample population, range of motion varied and was related to the severity of injury and the extent of skin grafting on the distal musculotendinous portion. Less function was exhibited in the compartment syndrome group (group II).

Conclusion: Functioning muscle transfer can be performed posttraumatically in lower limbs with composite soft-tissue and motor-unit defects, resulting in acceptable functional results and reliable limb salvage.

PubMed Disclaimer

References

    1. Hallock, G. G. Simultaneous transposition of anterior thigh muscle and fascial flap: An introduction to the chimera flap principle. Ann. Plast. Surg. 27: 126, 1991.
    1. Lin, C. H., Wei, F. C., Levin, L. S., et al. Free composite serratus anterior ribs flaps for lower limbs composite bone and soft tissue defects. Plast. Reconstr. Surg. 99: 1656, 1997.
    1. Lin, C. H., Wei, F. C., Lin, T. T., Yeh, J. T., Rodriguez, E. D., and Chen, C. T. Lateral circumflex femoral artery system: A warehouse for functional composite free tissue reconstruction of the lower leg. J. Trauma 60: 1032, 2006.
    1. Harrison, D. H. The pectoralis minor vascularized muscle graft for the treatment of unilateral facial palsy. Plast. Reconstr. Surg. 75: 206, 1985.
    1. Ikuta, Y., Kubo, T., and Tsuge, K. Free muscle transplantation by microsurgical technique to treat severe Volkmann's contracture. Plast. Reconstr. Surg. 58: 407, 1976.

LinkOut - more resources