Gracilis functioning free muscle transplantation for reconstruction of severely injured upper extremity; Experience of 201 cases

201 gracilis functioning free muscle transplantation {FFMT) performed to reconstruct complex injuries of the upper extremity during 1986-99 were reviewed. The indications included chronic and irreparable brachia plexus injuries, Volkmann's ischemic contracture, post replantation, triple nerve injuries, crush injuries to major muscle groups. The functional muscle group reconstructed included elbow flexion, finger and wrist flexion and wrist and finger extension. Overall successful results (grade IV power) was obtained in 74% of the cases. The functional recovery was better when the original motor nerve was used compared to nerve transfers. In nerve transfers, recovery was better with intercostal and spinal accessory nerve compared to cross chest C-7 and phrenic nerve transfer. Elbow flexion recovered better than other groups reconstructed. Gracilis functioning muscle transplantation offers a viable option for reconstruction of severely injured upper limb.