Functioning free muscle transplantation to the lower leg

Many authors have reported on transplantation of functioning free muscle to the upper extremities, but few reports are available on functioning free muscle transfers to the lower extremities, where injuries have hitherto been treated mainly with tendon transfers. However, under suitable conditions, better results can be obtained using a functioning free musculocutaneous flap transfer to treat extensor muscle loss in the lower leg. The authors reconstructed the anterior extensors in two patients suffering from lower-leg necrosis. Ankle-joint active dorsiflexion was restored, and dorsiflexion in the ankle joint of about 0 degree was achieved; however, recovery of ankle-joint range of motion was limited by contracture of the ankle joint, due to associated injury, even when the strength and excursion of the grafted muscle were sufficient.