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Bekisz et al. Plast Aesthet Res 2022;9:61 Plastic and
DOI: 10.20517/2347-9264.2022.69
Aesthetic Research

Review Open Access

Complex upper extremity injuries: targeted muscle
reinnervation, free functional muscle transfer, and

vascularized composite allotransplantation

Jonathan Bekisz 1 , Jacques H. Hacquebord 2
1
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY 10016, USA.
2
Department of Orthopedic Surgery/Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New
York, NY 10016, USA.
Correspondence to: Dr. Jacques H. Hacquebord, Department of Orthopedic Surgery/Hansjörg Wyss Department of Plastic
Surgery, New York University Langone Health, 555 First Avenue, New York, NY 10016, USA. E-mail:
jacques.hacquebord@nyulangone.org

How to cite this article: Bekisz J, Hacquebord JH. Complex upper extremity injuries: targeted muscle reinnervation, free
functional muscle transfer, and vascularized composite allotransplantation. Plast Aesthet Res 2022;9:61.
https://dx.doi.org/10.20517/2347-9264.2022.69

Received: 27 Jun 2022 First Decision: 9 Oct 2022 Revised: 12 Oct 2022 Accepted: 9 Nov 2022 Published: 28 Nov 2022

Academic Editors: Matthew Iorio, Harvey W.M. Chim Copy Editor: Peng-Juan Wen Production Editor: Peng-Juan Wen

Abstract
Restoration of upper extremity function poses a unique surgical challenge. With considerations ranging from
ensuring appropriate skeletal support and musculotendinous and ligamentous anatomy, restoring adequate
vascularity and innervation, and providing sufficient soft tissue coverage, upper extremity injuries present a diverse
range of reconstructive problems. Recent history has been marked by an expansion of novel techniques for
addressing these complex issues. Sophisticated modalities, such as targeted muscle reinnervation, free functional
muscle transfer, and vascularized composite allotransplantation, have become some of the most powerful tools in
the armamentarium of the reconstructive surgeon. This review article aims to define the distinguishing features of
each of these modalities and reviews some of their unique advantages and limitations.

Keywords: Targeted muscle reinnervation, free functional muscle transfer, vascularized composite
allotransplantation

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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