Free gracilis transfer to restore finger flexion in Volkmann ischemic contracture

Volkmann ischemic contracture is a devastating injury, which can lead to severe dysfunction of the upper extremity in the pediatric population. This can result in an insensate hand with minimal finger motion and use. Before the inciting injury this is usually a normal upper extremity. Patients with severe contractures require complex reconstruction that use either tendon transfers or free functioning muscle transfer. Many times the wrist extensors are not available as tendon transfers because of their involvement in the initial process. At our institution, we took a 2-stage approach to this difficult problem, which involves initial muscle debridement and neurolysis followed by second-stage free functioning muscle transfer after return of sensation and intrinsics to the hand. We feel that this optimizes our result in the patients with severe Volkmann ischemic contracture. We present our technique for 2-stage reconstruction using free functioning muscle transfer in the pediatric patient.