Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 18:
Vascularized Muscle Transplantation and Gracilis Muscle Transplantation
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  The expendability of the muscles used and the acceptability of the donor site are other favorable factors in muscle transplantation (with the possible exception of the tensor fascia lata). Finally, the ability to reoperate through the muscle at a later date to perform secondary reconstructive procedures enhances the attractiveness of this type of transplant. The ability of the muscle to carry an overlying skin island adds to the versatility of these procedures, but is now rarely used in our practice. The use of the muscle without an overlying skin island permits linear closure of the donor area, avoiding the irregular hyperpigmented skin-graft defects created when these donor wounds cannot be closed primarily. The transplanted muscle accepts a skin graft readily, and these grafts do not hyperpigment as do skin grafts on other beds.7-9

The second major indication for microvascular muscle transplantation has been for restoration of depleted or destroyed muscular function in the extremities (primarily upper) and the face. The gracilis and serratus anterior muscle have been particularly useful in these situations. The readily accessible and specific motor nerves of these muscles, along with other advantages, make them well suited for functional muscle transplantation.

INDICATIONS

The most common indications for microvascular transplantation are as follows:

 

1.Difficult wound coverage problems.

A. Exposed vital structures, e.g., bone tendon, nerve, vessels with or without accompanying exposed alloplastic material such as metal for bony internal fixation, vascular grafts, exposed prostheses, or cranioplast material.


B. A paucity of local available tissue, e.g., wounds in the distal portions of the extremities or wounds surrounded by multiple scars from previous procedures. Amputation stumps and heel and sole defects of the feet are common indications in this area.


C. Poorly vascularized recipient beds, such as irradiated or chronically infected wounds, beds with extreme post-traumatic or postoperative scarring, and beds that have sustained thermal or electrical burns.


D. Situations that will require further reconstructive procedures on underlying structures in the future, such as a poorly vascularized non-healing wound over an ankle that will subsequently require fusion, or an open area over a tibial defect that will subsequently require bone grafting.


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