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Mitchell et al. Plast Aesthet Res 2023;10:35 https://dx.doi.org/10.20517/2347-9264.2023.14 Page 7 of 12
Figure 3. Medial thigh approach and final product of gracilis free functional gracilis muscle harvest. Gracilis FFMT utilizes medial
femoral circumflex vessel, obturator nerve and a skin paddle.
Figure 4. Modified Doi procedure for two-stage double free functional gracilis transfer. A) Stage 1 transfer, innervated by a SAN
transfer, attempts to restore elbow flexion and wrist extension. B) Stage 2 transfer, innervated by ICN 5-6, augments elbow flexion
while adding finger flexion. Additional ICN 3-4 transfers are performed for triceps neurotization. Copyright Permission: Bishop AT.
Functional free-muscle transfer for brachial plexus injury. Hand Clin. 2005;21:91-102.
Hand sensation
In the same surgical setting as the second FFMT, sensory rami of the ICN are harvested and transferred to
LCMN. These lateral sensory rami pierce the muscles of the lateral thoracic wall and divide into an anterior
and posterior sensory branch. Within the submammary flap created for motor ICN harvest lies the sensory
nerve branches. Recommended techniques involve the harvest of three sensory rami and direct coaptation
with the LCMN.
