Objective To explore the clinical effect and experience of three kinds of functional free muscle transplantation in the reconstruction of partial upper limb function. Methods From January 2010 to December 2018, functional free gracilis , latissimus dorsi and pectoralis minor muscle transplantation were applied to reconstruct upper limb function in 39 cases, including reconstructing elbow flexion and finger flexion function in 6 cases, finger flexion function in 11 cases, and thumb opposable function in 22 cases. Different dynamic nerves and blood supply vessels were selected according to the conditions of the limbs, and the transplanted muscles were adjusted in the optimal position of muscle tension during the operation to rebuild the nerve and blood supply of the transplanted muscles. Results In 37 cases, the functional free muscle survived completely, and the reconstructed upper limb recovered well. Excellent and good rates were 94.8%. In 2 cases, the reconstructed function did not get recovered, and 1 case occurred partially necrotic in the transplanted muscle and flap. Conclusions The functional free gracilis, latissimus dorsi and pectoralis minor muscle transplantation have a satisfactory result in the reconstruction of upper limb function, which is an effective method for the treatment of various causes of upper limb muscle defects and severe limb disorders.
Key words
Muscle transplantation /
Pectoralis minor /
Gracilis /
Latissimus dorsi /
Upper limb；Functional reconstruction
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References
[1] Chen CW. Free muscle transplantation by microsurgical neurovascular anastomases[J]. Chin Med J (Engl), 1976, 2(1): 47-50.
[2] Ikuta Y, Kubo T, Tsuge K. Free muscle transplantation by microsuigical techniques to treat severe Vollkmann's contracture[J]. Plast Reconstr Surg, 1976, 58(4): 407-411.
[3] 庄永青, 付强, 常丽鹏, 等. 携带皮瓣的胸小肌移植重建拇对掌功能的解剖与临床研究[J]. 中华手外科杂志, 2013, 29(3): 139-142.
[4] 潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准[J]. 中华手外科杂志, 2000, 16(3): 130-135.
[5] Lin SH, Chuang DCC, Hattori Y, et al. Traumatic major muscle loss in the upper extremity: reconstruction using functioning free muscle transplantation[J]. J Reconstr Microsurg, 2004, 20(3): 227-235.
[6] 薛云皓, 王树锋, 陈山林, 等. 游离股薄肌移植重建上肢部分功能24例报告[J]. 中国骨与关节杂志, 2007, 6(4): 262-265.
[7] Terzis JK, Papakonstantiou KC. The surgical treatment of brachial plexus injuries in adults[J]. Plastic Reconstr Surg, 2000, 106(5): 1097-1124.
[8] Chuang DC, Yeh MC, Wei FC. Intercostal nerve transfer of the musculocutaneous nerve in avulsed brachial plexus injuries: evaluation of 66 patients[J]. J Hand Surg Am, 1992, 17(5): 822-828.
[9] Cho BC, Lee JH, Ramasastry SS, et al. Free latissimus dorsi muscle transfer using an endoscopic technique[J]. Ann Plast Surg, 1997, 38(6): 586-593.
[10]Spiegel JH, Lee C, Trabulsy PP, et al. Endoscopic harvest of the gracilis muscle flap[J]. Ann Plast Surg, 1998, 41(4): 384-389.
[11]庄永青, 熊洪涛, 付强, 等. 胸小肌移植重建拇对张功能的解剖与临床研究[J]. 中华显微外科杂志, 2007, 30(5): 323-327.
[12]付强, 庄永青, 傅小宽, 等. 携带皮瓣的胸小肌移植重建拇对掌功能的应用解剖研究[J].中国临床解剖学杂志, 2008, 26(6): 598-600.
[13]Yong-Qing Zhuang, Hong-Tao Xiong, Qiang Fu, et al. Functional pectoralis minor myocutaneous flflap transplantation for reconstruction of thumb opposition: an anatomic study with clinical applications[J]. Asian J Surg, 2018, 41(4): 389-395.
[14] Fridén J , Lieber RL. Evidence for muscle attachment at relatively long lengths in tendon transfer surgery[J]. J Hand Surg Am, 1998, 23(1): 105-110.
[15] 熊洪涛, 庄永青, 高庆鹏, 等. 兔肌肉移植中张力调节与功能恢复的实验性研究[J]. 中国临床解剖学杂志, 2014, 32(4): 451-454.
[16] 侯毅, 杨建涛, 秦本刚, 等. 股薄肌功能性肌肉移植术后肌肉恢复的B超评价[J]. 中华显微外科杂志, 2019, 42(2): 105-109.
[17]Yi Yang, Jian-Tao Yang, Guo Fu, et al. Functioning free gracilis transfer to reconstruct elbow flexion and quality of life in global brachial plexus injured patients[J]. Sci Rep, 2016, 6: 22479.
