Reconstruction of Forearm Muscle Loss with Innervated Gracilis Transfer: Experience with Modifications in Indications and Technique

The authors reported on their experience with microvascular innervated gracilis muscle transfer for reconstruction of the forearm musculature in 20 patients. A total of 21 muscles were transferred in this group. There was one flap loss due to vascular compromise (4.7%) of 21 muscles transferred. The average age of this group was 33 years (range: 3–47 years). All but one of the patients were males. There was one death in the series in a patient with psychiatric disorders who drowned in a hot tub after an overdose at 8 months postoperatively. Sixteen muscles were transferred to the flexor side of the forearm and 5 to the extensor side. Twelve patients had direct traumatic muscle injury or loss, 5 patients had established Volkmann's ischemic contracture, 2 patients had long-standing nerve injuries, and 1 patient had muscle excision for tumor removal. In the traumatic injury group, 8 patients had grafting of the median and/or ulnar nerve at the time of gracilis muscle transfer.