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Free functional muscle transplant involves taking an “extra” muscle and transplanting it somewhere else in the body to restore movement. For example, the gracilis muscle from the inside of the thigh — which is responsible for some movement in the leg — may be transplanted to replace the biceps in the arm.

Free-functioning muscle transplant: Gracilis muscle to replace the biceps muscle in the arm. The gracilis muscle is shown at the right thigh. The nerve to the gracilis muscle is indicated by the red arrow. AL, adductor longus. DFV, deep femoral vessels. G. gracilis muscle. ON, obturator nerve. S, sartorius muscle. (From Mackinnon SE, Novak CB. Nerve Transfers. Hand Clinics. 2008:24(4):357. Courtesy of Stephen H. Colbert, MD, Columbia, MO, and Elsevier.)

The transplanted muscle must be connected to an artery and vein in its new location to keep it alive. It then must be connected to a healthy nerve so that it can be used to move the limb.

As with tendon transfers, there is no time limit for performing free functional muscle transplants — the technique can restore muscle function many years after the initial injury.

This technique is particularly useful for restoring some very basic hand function after a severe brachial plexus injury. Because the distance to regenerate a nerve from the neck to the hand is usually too far to be successful, this new muscle is used instead and is not subject to the same time limitation.

Following this procedure, the patient must remain in the hospital for several days to ensure that the vessels to the new muscle continue to flow effectively so that it will stay alive and function in an effective manner.

Your surgeon will select free functional muscle transplant, tendon transfer, nerve tranfer, nerve graft, nerve release or other treatment based on your condition and which technique offers the best chance of recovery.