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Functioning free-muscle transplantation for the upper extremity.

Functioning free-muscle transplantation (FFMT) is an advanced microneurovascular technique indicated in patients who have an injury with major functional muscle or muscle group loss or denervation and no locally available or ideal musculotendinous donor units. Over the 9-year period, from 1986 to 1994, 47 FFMTs were applied in patients who had severe hand and upper-extremity injuries (not including brachial plexus injury). Thirteen patients had 15 FFMTs to reconstruct muscle loss caused by severe Volkmann's ischemia. Seventeen patients had 21 FFMTs for reconstruction after severe crushing and traction injuries of the forearm or arm, with major muscle loss or major nerve injury. Nine patients, with 11 FFMTs, sustained major limb avulsion amputation for which replantation without nerve repair was done initially. FFMT was the only technique available to resolve the motor deficit and consequent deformity. Most patients achieved significant functional improvement.