Free functional gracilis muscle opponensplasty for thenar reconstruction: Indications, technique, and long-term...

Thumb opposition is an essential component of human hand function, and loss of the thenar musculature creates substantial disability of the hand. Additionally, first web space contracture as a result of trauma is a substantial limitation in reconstruction of thumb opposition. Reconstruction of thenar function is most commonly performed via opponensplasty tendon transfers. Although beneficial, tendon transfers require cortical retraining and fall short of native function. These may be the only option in the case of median nerve palsy. However, at times, thenar function is lost owing to thenar muscle injury with preserved median nerve function. Common examples include palmar soft tissue trauma and compartment syndrome. In such cases, intuitive thumb opposition can be restored with free functional muscle transfer innervated by the thenar motor branch of the median nerve. In addition, first web space release can be achieved in the same procedure. Here, we have demonstrate the benefits of this procedure versus opponensplasty, review long-term outcomes of successful cases including videographic documentation of function, and provide expert guidance to surgeons considering performing this procedure.