Functional outcome of extensor carpi radialis longus transfer for finger flexion in posttraumatic flexor muscle loss

PURPOSE: The purpose of this study was to assess the functional outcome after extensor carpi radialis longus (ECRL) transfer for restoration of finger flexion in patients with flexor muscle loss after direct trauma. METHODS: We evaluated 8 patients who had ECRL transfer between 1995 and 2003. Flexion gained was assessed by measuring the digit-to-palm distance (DPD). The grip strength was compared with that of the opposite normal limb. The average follow-up period was 41 months. We compared the results obtained with other modalities of restoration of finger flexion, namely a pedicled latissimus dorsi muscle transfer or a free functioning muscle transfer (FFMT) using the series available in the literature. RESULTS: Four patients had a good result with a DPD of 0 cm in all fingers and an average grip strength of 65% of the opposite hand. Two patients had an average result with a DPD of 1.5, 2, 1.7, and 1.5 cm for the index, middle, ring, and small fingers, respectively, and an average grip strength of 58%; 2 patients had a poor result with a DPD of 5.0, 5.5, 5.0, and 3.0 cm for the index, middle, ring, and small fingers, respectively, and with an average grip strength of 21% of the opposite hand. CONCLUSIONS: The ECRL transfer yields good results if the intrinsic muscles of the hand are functioning, the extensor compartment is uninjured, and the lower third of the forearm where the tendon junction is performed is relatively unscarred. In such instances the range of movement and grip strength achieved are better than a latissimus dorsi muscle pedicle graft and are comparable with a FFMT. This is achieved earlier than the time taken for reinnervation of FFMT and without the attendant risks for flap failure. The ECRL transfer for finger flexor restoration is a more simple alternative that should be considered when possible.