Role of free functioning muscle transfer in improving the functional outcomes following replantation of crush avulsion amputations of the forearm

Replantation still remains the best form of reconstruction following major upper limb amputations. Regaining a functional limb is a challenge in avulsion amputations when there is entire loss of a compartment as it happens in proximal third of forearm amputations or when the avulsion occurs through the musculotendinous junction. In these circumstances, primary repair of the long flexors or extensors is not possible and options of secondary tendon transfers do not exist due to lack of donor tendons. These factors could weigh in negatively in making the decision for replantation at the time of presentation. We are presenting a series of 5 cases of avulsion amputation of the forearm wherein the functional outcome was enhanced by secondary Free Functional Muscle transfers (FFMT) using gracilis for finger flexion. Outcome scores improved from Chen IV to II in three patients and to III in two patients. The feasibility of gaining useful outcome through secondary procedures like FFMT should serve as an encouragement to extend the indications for replantation in avulsion amputations of the forearm.