Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 33:
Secondary Reconstruction After Replantation
  FIG. 33-79. The ulnar and median nerves were reconstructed with multiple 15 cm sural nerve grafts and the biceps tendon rebuilt with fascial graft.

FIG. 33-80. At 3 years, the patient has protective sensation in the hand and biceps strength.

FIG. 33-81. Improving finger flexion.

FIG. 33-82. Patient doing push-up.

FIG. 33-83. Patient arm wrestling.


A 26-year-old man suffered a devastating injury in a motor vehicle accident, avulsing the soft tissue and extension and flexor muscles of his left arm.

FIG. 33-84. Appearance of injury.

FIG. 33-85. Closure of the extensive wound was obtained with free transfer of the latissimus dorsi, reinnervated with the posterior interosseous nerve to allow wrist motion. Neutral.

FIG. 33-86. Useful wrist flexion.

FIG. 33-87. Finger extension.

FIG. 33-88. To improve finger flexion, a free functional gracilis transplant was later performed, reinnervated through the anterior interosseous nerve. Gracilis muscle ready for transplantation.


FIG. 33-89. Gracilis microneurovascular repair.

FIG. 33-90. A second functional gracilis transplant was subsequently performed and combined by tendon transfer to allow strong key pinch. Muscle belly contracted.

FIG. 33-91. Strong pinch.


A 32-year-old woman suffered a devastating injury in a motor vehicle accident. Her left elbow was crushed and there were multiple nerve forearm fractures.

FIG. 33-92. Appearance of injury.

FIG. 33-93. The ulnar and radial nerves were completely destroyed. Fortunately, the median nerve was intact.

FIG. 33-94. X ray of postreduction intramedullary stabilization of ulna.

FIG. 33-95. Complex reconstruction was performed with transposition of the latissimus muscle to power wrist extension and ulnar nerve grafting.

FIG. 33-96. Tissue expansion was used to remove skin grafts about the elbow.

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