Free Functioning Muscle Transfer for Lower Extremity Post-Traumatic Composite Structure and Functional Defect

The traumatized lower extremity may present not only a composite soft tissue defect, but also a certain functional disability. A microsurgical free functioning muscle transfer (FFMT) may provide structural reconstruction and functional restoration for composite tissue defects.

From 1996 to 2004, 18 lower extremity injured patients whose lesions exhibited composite soft tissue defects, with or without bone defects, and certain accompanying functional disabilities included 8 open fracture IIIB, 5 neglected compartment syndromes (4 IIIB, 1 IIIC), 4 crush injuries. Two patients received composite rectus femoris FFMT and vascular iliac crest for dorsiflexion reconstruction and tibial defect. Ten patients received 4 rectus femoris and 8 gracilis FFMT for dorsiflexion. Two received rectus femoris for posterior compartment defect and quadriceps defect reconstruction.

Two re-explorations were carried out and one was salvaged, but the other failed, resulting in a below-knee amputation. Five patients required skin graft for partial skin paddle necrosis. The ranges of motion were variable, related to the severity of injury and skin grafting on the distal musculotendinous portion. Compartment syndrome limb salvage presented less range of motion. All salvaged limbs could achieve full weight-bearing without assistance.

FFMT has been used successfully for upper limb motor defects and nerve palsy reconstruction. This reported application in the lower limbs can be performed with acceptable functional results and reliable limb salvage.