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In order for a patient to benefit from a free functioning muscle transfer, the donor nerve must be healthy (i.e. not subject to compression or ischemia) and the muscle must have adequate nutrient and blood supply. If either of these factors is compromised, the wound will not heal. If patients are unable to obtain donor nerves because of location or the donor nerve circulates poorly due to iliac compression, artery blowout or ischemia due to venous congestion, a free functioning muscle transfer would not be an option.
FFMT is an absolute indication when the nerve has been completely cut through and the donor muscle is free. If the motor nerve may be salvaged, have a functioning motor nerve is available and the donor muscle has a viable nerve supply, a free functioning muscle transfer is the reconstructive treatment of choice. FFMT can be employed in a number of clinical scenarios: (1) reconstruction of lower extremity or facial paralysis due to traumatic injury or a chronic nerve injury, (2) reconstruction of extremity muscles after amputation of the limb [54], (3) reconstruction of a functional hand after a brachial plexus injury [41].
Because of anatomical variations in length, width and/or thickness of the transferred muscle, proportionate to the size of the recipient muscle, the fold of the muscle may be up to half as long as the donor nerve and motor axon. Therefore, some muscle transfer will not be a viable option although many of the donor muscles are easily available, so an accurate and detailed preoperative analysis of an appropriate donor muscle and nerve is important in order to choose the best muscle for the right patient. The technique to transfer donor and recipient muscles requires strong microsurgical skills.
Many investigators have demonstrated that muscle and nerve re-growth occur within the most peripheral nerve of the limb [55, 56]. In fact, the peripheral nerve has been demonstrated to be the most anastomosis sensitive zone. This is where the axon of the donor nerve regenerates, inserts into the recipient nerve and becomes re-innervated. d2c66b5586