Pharmacologic enhancement of functional recovery in free muscle transfers

To date, most free muscle transfers have been marginally successful as functioning units, producing no more than 50 percent of the tension generated by an identical non-transferred muscle. Functional recovery depends both on revascularization and re-innervation, even after careful microvascular anastomosis, remains limited. Forskolin is a robust stimulator of adenylate cyclase and has been used to stimulate peripheral nerve regeneration in vivo; Forskolin may also directly increase capillary growth. Chronic infusion of Forskolin for the first 21 days following orthotopic transplantation of rabbit rectus femoris, with neurovascular anastomosis, stimulated a two-fold increase in the force-generating capacity of the transplant nine to 10 months after surgery. These results, in a model similar to clinical free muscle transfer, offer promise that Forskolin treatment can improve functional recovery by improving muscle re-innervation.