J Reconstr Microsurg 2011; 27(7): 439-444
DOI: 10.1055/s-0031-1281512
© Thieme Medical Publishers

Selective Fascicular Coaptation of Free Functioning Gracilis Transfer for Restoration of Independent Thumb and Finger Flexion Following Volkmann Ischemic Contracture

Ronald M. Zuker1 , Michael Bezuhly2 , Ralph T. Manktelow1
  • 1Division of Plastic Surgery, Hospital for Sick Children, Toronto, Ontario
  • 2Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
Further Information

Publication History

Publication Date:
21 July 2011 (online)

ABSTRACT

Children are prone to developing moderate to severe Volkmann ischemic contracture following a supracondylar fracture of the humerus or its treatment. Given the variable extent of forearm muscle damage, tendon transfers and tenodeses are often unavailable. To address these contractures, intensive hand therapy and a free functioning muscle transfer are required. Despite functional improvement following free muscle transplantation, reconstructed patients with severe Volkmann ischemic contracture tend to have persistent difficulty with fine motor activities owing to the losses of intrinsic muscle function and independence of thumb and finger flexion. The authors demonstrate how selective coaptation of separate fascicular territories of the gracilis nerve branches to the branches of the anterior interosseous nerve that innervate flexor pollicis longus and flexor digitorum profundus may be performed to establish a degree of independent thumb and finger flexion with a single free gracilis transfer. This technical refinement as well as its long-term outcomes in a series of three patients is presented.

REFERENCES

  • 1 Volkmann R. Die ischaemischen Muskallahmangen und Kontrakturen.  Central Chin. 1881;  8 801-803
  • 2 Shanghai Sixth People's Hospital . Free muscle transplantation by microsurgical neurovascular anastomoses. Report of a case.  Chin Med J (Engl). 1976;  2 (1) 47-50
  • 3 Ikuta Y, Kubo T, Tsuge K. Free muscle transplantation by microsurgical technique to treat severe Volkmann's contracture.  Plast Reconstr Surg. 1976;  58 (4) 407-411
  • 4 Manktelow R T, Zuker R M, McKee N H. Functioning free muscle transplantation.  J Hand Surg Am. 1984;  9A (1) 32-39
  • 5 Zuker R M, Egerszegi E P, Manktelow R T, McLeod A, Candlish S. Volkmann's ischemic contracture in children: the results of free vascularized muscle transplantation.  Microsurgery. 1991;  12 (5) 341-345
  • 6 Ercetin O, Akinci M. Free muscle transfer in Volkmann's ischaemic contracture.  Ann Chir Main Memb Super. 1994;  13 (1) 5-12
  • 7 Doi K, Sakai K, Ihara K, Abe Y, Kawai S, Kurafuji Y. Reinnervated free muscle transplantation for extremity reconstruction.  Plast Reconstr Surg. 1993;  91 (5) 872-883
  • 8 Manktelow R T, Zuker R M. Muscle transplantation by fascicular territory.  Plast Reconstr Surg. 1984;  73 (5) 751-757
  • 9 Sammer D M, Chung K C. Tendon transfers: Part II. Transfers for ulnar nerve palsy and median nerve palsy.  Plast Reconstr Surg. 2009;  124 (3) 212e-221e

Ronald M ZukerM.D. F.R.C.S.C. F.A.C.S. F.A.A.P. 

Division of Plastic Surgery, Hospital for Sick Children

Suite 5416, 555 University Avenue, Toronto, ON M5G 1X8, Canada

Email: ronald.zuker@sickkids.ca