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Page 4 of 10 Nguyen et al. Plast Aesthet Res 2019;6:31 I http://dx.doi.org/10.20517/2347-9264.2019.42

Figure 2. Artist rendition of surgical technique

Figure 3. Neurorrhaphy of motor branch of obturator nerve to motor nerve of rectus femoris

adjustable hinged knee splint and begin range of motion exercises that increase by 20° increments every
week. Simultaneously motor frequency transcutaneous electrical nerve stimulation is begun. As soon
as MRC grade 1 contraction is identified (a flicker of muscle contraction), the patients begin quadriceps
strengthening exercises. Many standard strengthening techniques cannot be used because the knee is
unstable from lack of quadriceps tone and therefore the ones shown in Figure 4 allow the patient to vary
the degree of force on the new muscle as it gets stronger while also allowing them to provide stability to
their knee by offloading forces onto their upper extremities.

RESULTS
We performed a gracilis muscle transfer to replace total quadriceps function in four patients with large
central sarcoma resections resulting in large central gaps and/or denervation of all four quadriceps
muscles. Patient’s age at the time of surgery ranged from 24 to 65 years. Follow up in the three patients
still alive ranged 3-20 years, with the single deceased patient surviving under three months following
surgery and dying as a result of metastatic disease. All patients had high grade sarcomas, Fédération
Nationale des Centres de Lutte Contre le Cancer Grade 3, and all surviving patients had negative margins