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Page 4 of 11 Marsden et al. Plast Aesthet Res 2019;6:24 I http://dx.doi.org/10.20517/2347-9264.2019.14

A B

C D

Figure 1. Clinical images of functional upper limb reconstruction with a combination of free functioning muscle transfer and nerve
transfer in an 83-year-old patient. A: right arm defect following sarcoma excision including 100% of biceps and over 50% of brachialis,
which was denervated. This was reconstructed with a free innervated gracillis myocutaneous flap with the nerve coaptated to the cut end
of the musculocutaneous nerve, along with a flexor carpi ulnaris branch to brachialis branch nerve transfer; B: results after 12 months,
demonstrating very good cosmesis and contour; C, D: active elbow flexion from 110° to 40° with M4 power (see Video 1)

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E F

Figure 2. Example of lower limb functional reconstruction with functional muscle transfer, nerve grafts and nerve transfers in a 30-year-
old female. A: large defect to left groin following excision of sarcoma, which included femoral nerve and iliopsoas and sartorius muscle
resection, also demonstrating exposed femoral artery and vein; B: nerve grafts performed using cutaneous femoral nerve branches, from
proximal stump to quadriceps branches; C: pedicled, innervated rectus femoris myocutaneous flap raised prior to inset to reconstruct hip
flexors; D: adductor longus nerve transfer to vastus medialis oblique branch; E: final result after inset and closure; F: patient had full return
of hip flexors and quadriceps function, and was able to run, climb and descend stairs at 18 months (see Videos 2 and 3)