Current surgical outcomes of free functional muscle transfer for Volkmann's ischemic contracture: A scoping review

Free functional muscle transfer (FFMT) is a versatile surgical option for restoring function in cases of acute trauma, ischemic contracture, or tumor resection. FFMT is often considered a last resort due to procedural complexity and lack of microsurgical availability. While FFMT is well described for brachial plexus injury and facial trauma, its application in Volkmann's ischemic contracture (VIC) is underexplored, with variable operative timelines and postoperative outcomes.

Following PRISMA-ScR guidelines, PubMed and Ovid electronic databases were searched using the following keywords: "Volkmann," "compartment syndrome," "muscle transfer," "muscle transplantation," and/or "reconstruction." Studies were imported into Covidence, and screening was performed by two independent reviewers. Patient characteristics, surgery information, and postoperative clinical data were extracted.

The scoping review included 21 studies. In total, 163 FFMTs for VIC were performed, most commonly using the gracilis muscle (64.4 %) for finger flexion deficits (91.4 %). Nerve selection was variably reported, with the anterior interosseus nerve (AIN) used most frequently. Grip strength, range of motion, and total active motion were the most frequently utilized outcome measures. FFMT success rates were high (96 %), and 34.6 % of all-comers experienced tendon or muscle adhesions that required subsequent tenolysis or adhesiolysis. Several studies recommended early exploration within 3 weeks, and FFMT within 6 months of the initial injury; however, successful FFMT cases were reported up to 20 years post-injury.

FFMT remains a viable option for VIC treatment, with a 96 % success rate. There is a relatively high incidence of tendon or muscle adhesions (34.6 %) that require secondary procedures.