Free functional muscle transfer for upper limb paralysis - A systematic review

Area of Science:

• Reconstructive surgery
• Upper limb paralysis treatment
• Microsurgery

Background:

• Upper limb paralysis presents a significant reconstructive challenge.
• Free functional muscle transfer (FFMT) is an option for patients lacking local tissues or with delayed presentation.
• This review synthesizes evidence on FFMT for upper limb paralysis reconstruction.

Purpose of the Study:

• To systematically review the evidence for Free Functional Muscle Transfer (FFMT) in reconstructing upper limb paralysis.
• To summarize outcomes and identify limitations in current research.

Main Methods:

• Systematic review of MEDLINE and EMBASE databases.
• Methodology adapted from Cochrane Handbook and PRISMA statement.
• Narrative synthesis of data from included observational studies; risk of bias assessment.

Main Results:

• 39 observational studies including 904 patients were analyzed.
• Brachial plexus injury was the most common cause (81.4%).
• Outcomes were heterogeneous; many FFMTs had suboptimal post-operative muscle strength (MRC grade <4 in nearly half). Mean flap failure rate was 3.6%.

Conclusions:

• FFMT may be effective for upper limb paralysis, but current evidence is limited.
• Lack of consensus on outcome measures and prognostic factors hinders definitive conclusions.
• Improved study design, standardized reporting, and patient-reported outcome measures (PROMs) are crucial.