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In 1970 Tamai1 transplanted the
biceps brachii and rectus femoris muscles from the hind limb to the
contralateral hind limb in a dog along with an artery, vein, and motor
nerve repair. Four months after transplantation and microneurovascular
repair, early degenerative changes and fibrillation potentials were
replaced by normal muscle architecture and M-wave potentials consistent
with healthy functioning neuromuscular units. From this seminal scientific
study, reconstructive surgeons were able to envision muscle
transplantation for restoration of function and not simply for provision
of soft tissue coverage. Since then, experimental2-5 and
clinical6-10 studies have combined to make functional
microvascular muscle transplantation (FMMT) a reliable technique in
reconstructive surgery of the extremities and in facial reanimation.
Muscle groups in the arms and legs work in a
synergistic fashion to perform specific motions such as extension or
flexion across a joint. When all muscles in a synergistic group are
denervated or destroyed, motion is lost. When available, tendons can be
transferred (tendon transfer) from an adjacent muscle compartment to
restore lost function. When local muscles are also affected, as in limb
replantation, or when major soft tissue or major nerve crush or avulsion
injury is present, a functional microvascular muscle transplant can be
utilized to overcome the barriers presented by extensive injury.
Our approach to muscle transplantation to
restore function is based on the work of the other major microsurgical
centers in the world as well as the evolution of our clinical experience
and research. The goal of functional muscle transplantation is to restore active motion and satisfy a
patient’s particular functional need. To be successful, this requires that
certain criteria be met:
Criteria for the microsurgeon
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comfortable with nerve selection,
physiology, topography, microneural technique
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creativity
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must be familiar with all available
techniques to reach optimal functional potential
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comfortable with microvascular technique
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works closely with certified therapists
Criteria for appropriate patient selection
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supple-mobile joints
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adequate vessel and nerve target
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healthy recipient bed
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good skin cover
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highly motivated, especially given multiple
procedures
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extensive rehabilitation
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adequate limb sensibility
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understands the concepts involved and
therefore participates in care and rehabilitation
Selection of appropriate donor muscle
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adequate size, length, and tendon
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reliable neurovascular pedicle
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adequate strength to restore desired
function
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adequate excursion to restore desired
function
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minimal disability at donor site
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