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Free Functioning Muscle Transplantation for Lower Leg Neuropathy
Nai-Jen Chang, MD; David Chwei-Chin Chuang
Chang-Gung Memorial Hospital, Taoyuan, Taiwan
Free Functioning Muscle Transplantation for Lower Leg Neuropathy Author: Nai-Jen Chang, David Chwei-Chin Chuang Institution: Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan Background: The incidence of lower extremity nerves injuries is relatively rare and the results are usually poorer compare with upper extremities. Free functioning muscle transplantation (FFMT) is a choice of reconstruction for the sequalae of chronic neuropathy or the poor result of nerve reconstruction. However, there were limited cases reported in the literature review. Here we share our 20 years clinical experience using FFMT to reconstruct the lower leg neuropathy. Material and method: Between 1989 and 2010, 11 cases suffered from sciatic nerve neuropathy with devastating clinical recovery of ankle dorsiflexion included in our studies. There were 6 male and 5 female, with the average of 27.7 (13-49) years old. The etiology of injury including traffic accident (n=6), penetrating injury (n=2), explosive injury (n=1), falling from height (n=1), and crushing injury (n=1). 8 cases received FFMT after primary injury with an average of 16.6 (2-31) month post primary injury, another 3 cases received FFMT after poor result of serial nerve surgeries. The donor site of free functioning muscle including rectus femoris muscle (n=7), gracilis (n=3), and lattismus dorsi (n=1). Concomitant operation were performed simultaneously such as calcaneous tendon lengthening (n=4), tibialis posterior tendon transfer to 3rd or 4th metatarsus (n=3), direct neurotization (n=1) and nerve graft (n=1) for outcome improvement. All the patients received regular rehabilitation post-operatively; all the patients follow up at least 1 year. Results: Between the 11 cases, only one rectus femoris (RF) muscle failed due to anterior tibial artery (ATA) occlusion which we then shifted to gracilis muscle. The survive rate of muscle flap was 90.9%. 7/11 patients achieved at least M3 post-op. Only one patient received tendon transfer because of poor result from the transferred functioning muscle. Conclusion: FFMT is an efficient way to regain the dorsiflexion of ankle for the patient with sciatic nerve or peroneal nerve palsy. Concomitant operation such as calcaneous tendon lengthening, tibialis posterior tendon transfer to metatarsus, or any kind of nerve surgeries can be done simultaneously for outcome improvement.
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