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Restoration of Finger Flexion in Children Using Functioning Free Gracilis Transfer
Mohamed Mostafa Kotb, MD
Assiut University Hospital, Assiut, Egypt

Introduction: Finger flexion is yet the most difficult task to achieve in upper limb reconstruction.

Patients and Methods: A study on 30 Children were operated upon from for restoration of finger flexion via free vascularized gracillis muscle transfer. The mean follow up period was 71.87 months (about 6 years). The mean age: 7.83 years (range 4 to 12years). 13 of the children were girls (57%). 14 cases (60%) were operated upon by FFMT before one year has passed since the incident. 14 cases had Volkman's ischemic contracture, 6 cases OBPP, 2 cases traumatic muscle loss, one case post tumor excision. FFMT was the first operation in 7 children (30.4%). All muscles harvested were with skin monitors. 16/18 muscles restoring finger flexion only were anastomosed to the ulnar artery or a side branch of it. 3/5 muscles restoring elbow and finger flexion were anastomosed to the thoracodorsal a.

Results: 24 autotransplants survived (80%). Clinical active motion started after the operation by a mean of 4m. The mean total active range of finger flexion very highly significantly increased from a preoperative 10.47 (4.36%) to 141.96 (64%) {of the available passive ROM}. In cases of Volkmann's ischaemic contracture best results are obtained when the patient is operated within 6 months from the incident injury. 73.9% of the cases had M0 active power grade before the operation. 78.2% of the cases reached M4 muscle power grade at late follow up. 51.4% of the cases, had further reconstruction during the follow up period 65.7% of the patients, are probably still in need for further reconstructive procedures. Tenolysis was the most frequently done operation after FFMT. 88% of the children in this series had other operation (s) besides that for FFMT.

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