Abstract
Free functional muscle transfer (FFMT) is a salvage procedure recommended in cases
of brachial plexus injury with late presentations or failures of primary nerve reconstruction.
The workhorse for most authors is the gracilis, and the most common indication is
the restoration of elbow flexion. For successful revascularization of the muscle,
donor vessels must be in proximity of the site of the muscle fixation and allow direct
coaptation to a donor nerve, ideally without the use of nerve grafts. A major problem
occurs when patients have sustained concomitant vascular injuries to the subclavian
and/or axillary arteries and had previous surgical dissections in the area where the
most common vascular pedicles are located. The authors report the use of the rerouted
facial vessels as donors in these complex cases. The surgical technique is presented,
along with three cases where the procedure was used. The flaps survived in all the
patients and grade > 3/5 muscle contraction was observed in the two patients who had
adequate follow-up. Conclusion: the use of the facial vessels as donor vessels is
an option to revascularize a FFMT in the setting of severe vascular injury to the
subclavian and axillary arteries.
Keywords
free functional muscle transfer - brachial plexus - gracilis - elbow flexion - facial
artery
