WHAT YOU SHOULD KNOW
After severe nerve or limb damage many functions may be lost. In more serious cases, the number of reconstructive options may be limited. More conventional strategies such as direct nerve repair, nerve grafting, nerve transfers, or tendon transfers may not be possible. When the muscles that move the fingers have been completely destroyed but a source of nerve supply in the region of the elbow exists, the whole muscle unit can be replaced by a transfer of a muscle from the thigh, completely separated from the body and reinserted in the forearm. Special microsurgical connections between small blood vessels and nerves are necessary to make the transferred muscle unit function properly.
MEDICAL HISTORY
All the details of the original injury and subsequent treatments must be reviewed. The patient should bring the typewritten reports of any previous surgeries that have been performed.
EXAMINATION
Joint range of motion, preserved or repaired tendon functions, and the elasticity and stability of wounds on the limb will be carefully noted. Evidence of specific nerve functions is critical to planning the reconstruction.
ADDITIONAL TESTS
Electrical nerve tests may need to be done to prove the existence of a nerve that can supply the transferred muscle once it is moved into the forearm.
TREATMENT OPTIONS
| TENDON TRANSFER | FREE FUNCTIONING MUSCLE TRANSFER | |
| CONSISTS OF | Moving a working tendon from its original assignment to one needed to make up for one of the lost movement functions | Transferring a muscle from the thigh into the forearm or arm to become the replacement for a damaged muscle |
| FEATURES | Only tendons that can afford to give up their original function are used | Nerve at the receiving site is connected to the transferred muscle to make it work |
| ADVANTAGES | Simpler solution | Used when there are no nearby tendons available for tendon transfer |
| DISADVANTAGES | Substitution with a tendon transfer can never really recreate the original lost function and the brain must learn to use the new connection | Complicated solution, requires nerve regrowth to work |
RECOVERY
The patient is kept in the hospital for 5 days of continuous anticoagulant medication by vein to prevent clotting of the small blood vessel connections that have been sewn together. After discharge, outpatient rehabilitation begins to ensure good joint movement and sliding of the tendon portion of the reconstruction. The muscle will not work yet at this time point. After nerve regrowth occurs months later, evidence of muscle contraction will appear. The patient then returns to therapy to practice exercises designed to help the new nerve to muscle connections develop and the transferred muscle to work.
