FIG. 18-51. At a later operation, the left gracilis was transplanted to the volar forearm muscles and the motor nerve anastomosed to the anterior interosseous muscle next to recipient bed.

FIG. 18-52. Distal common flexors were hooked to the distal gracilis tendon.

FIG. 18-53. Gracilis muscle covered with meshed skin graft.

FIG. 18-54. With the restoration of triceps function and elbow extension, the antagonistic biceps muscle hypertrophied. Finger flexion produced by gracilis transplant.

FIG. 18-55. Finger extension provided by the latissimus. Function was improving when the patient was last seen.

CASE 10

A 47-year-old electrician suffered a severe electrical burn to his dominant left hand with loss of the thumb and index finger.

FIG. 18-56. Original injury.

FIG. 18-57. After great-toe-to-thumb transplant and flexor tenolysis.

FIG. 18-58. The first web space was tight.

FIG. 18-59. A second microvascular transplant was performed, using the gracilis muscle to widen the first web space. The distal muscle was split to surround the base of the toe transplant and reinnervated with the proximal nerve branch to the pronator quadratus, to improve thumb opposition.

FIG. 18-60. Flexion.

FIG. 18-61. Extension.

References

1. Harii, K., Ohmori, K., and Torii, S.P.: Free gracilis muscle transplantation with microvascular anastomoses for the treatment of facial paralysis. Plast. Reconstr. Surg. 57:133, 1976.

2. Manktelow, R.T., and McKee, N.M.: Free muscle transplantation to provide active finger flexion. J. Hand Surg. 3:416, 1978.

3. Heckler, F.: Gracilis myocutaneous and muscle flaps. Clin. Plast. Surg. 7:27, 1980.

4. Ger, R.: Muscle transplantation for treatment and prevention of chronic post-traumatic osteomyelitis of the tibia. J. Bone Joint Surg. 59A:784, 1977.

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