Free functional muscle transfers

Free-functioning muscle transfer is done to replace lost muscle and tendon-unit function through microvascular anastomosis in the recipient area. Neural coaptation of the transferred muscle's motor nerve provides the ability of the muscle to contract, giving functionality to the transfer. It is a complex surgical technique with limited indications and prolonged patient recovery. Free functional muscle transfer represents the last chance after conservative approaches have been exhausted and functional deficiencies persist after a trauma, oncologic resection, congenital defect or acquired deficiencies. The manuscript is structured in paragraphs covering indications, patient selection, the surgical technique, complications and future prospective. It furthermore presents through detailed descriptions and photographic material clinical cases from our practice.