6. A systemic rehabilitation program of the grafted muscle must be started, including electric stimulation, biofeedback, and the use of dynamic splints.

APPLICABILITY

More than any other single factor, vascularized muscle transplantation has broadened the scope of elective microvascular surgery. 1-3 The ability to provide vascularized coverage of difficult wounds of all sizes and locations by microvascular muscle transplantation has freed the reconstructive surgeon from the constraints of a paucity of local tissue and the disadvantages of multistaged, random pedicle transfer. In addition, a growing body of evidence supports the use of muscle as superior coverage in difficult wounds, particularly when infection or alloplastic materials are involved. 5,6 This has been true in cases of acute, subacute, and chronic wounds. This versatile addition to the reconstructive armamentarium has proven as dependable as or more dependable than the more traditional methods of wound closure.

Many factors contribute to the attractiveness of muscle transplantation for covering difficult wounds. The wide range of donor-muscle size and shape makes the range of recipient wound applications broad. Vascularized coverage can be provided by a portion of muscle as small as 2 x 5 cm slip of the serratus anterior and as large as a 20 x 40 cm entire latissimus dorsi muscle, which can have two or three slips of the serratus anterior muscle attached as well.

The predictably consistent anatomy of the vascular pedicle in both diameter and location greatly facilitates the use of muscles for microvascular transplantation. In particular, the latissimus and serratus muscles may be transplanted on vascular pedicles that consist of vessels 2 to 3 mm in diameter. The lengths of the vascular pedicle for the latissimus and serratus muscles are such that it is often possible to do the anastomoses out of the zone of injury or irradiation without the need for interpositional vein grafts. It is critical to do the vascular anastomoses out of the zone of injury. Attempting to anastomose injured vessels is the single most common cause of transplant failure.

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