Abstract Computed tomography (CT) was performed to
evaluate the postoperative changes in free reinnervated
muscles of 11 patients with soft tissue sarcomas. The
muscle exhibited isodensity in six patients and low den-
sity in three. These nine patients had satisfactory recov-
ery of the muscle without any clinical difference be-
tween the two groups. The remaining two muscles,
which had unsatisfactory recovery, exhibited a mixture
of very low and low density. The existence of a very low
density area was thus related to worse recovery of func-
tion. Six of 11 patients underwent multiple CT at various
stages after surgery. The cross-sectional area of the mus-
cle changed significantly over time, and in five of the six
transplants temporary shrinkage was observed for up to
1 year before muscle bulk increased. The muscle main-
tained its initial bulk at a mean follow-up of 111 months.
These results indicate that CT can provide invaluable in-
formation on the structural changes in the free muscle.
Keywords Muscle/functioning · Computed
tomography · Tissue transfer · Postoperative change
Free functioning muscle transplantation has often been
employed to solve devastating problems of the extremi-
ties such as brachial plexus injury , Volkmann’s con-
tracture , and extensive muscle defects after trauma or
oncological resection [2, 6]. The early stages of muscle
recovery are monitored using electromyography, which
objectively demonstrates the reinnervation of the muscle.
After recovery of the muscle, muscle manual testing is
performed to evaluate and monitor the function of the
muscle. Compared with these electrophysiological and
clinical examinations, structural changes to the muscle
after transplantation are rarely examined.
Imaging studies using computed tomography (CT)
have been performed to evaluate the skeletal muscle in
terms of measurement of density and cross-sectional area
. In addition, CT and other modalities such as mag-
netic resonance imaging, and ultrasonography have been
used to evaluate the postoperative changes in nonrein-
nervated muscle flaps [7, 8, 9]. We performed CT to
evaluate the postoperative changes in the free function-
Material and methods
The study included 11 patients with soft tissue sarcomas in the ex-
tremity (6 men, 5 women; mean age 41 years, range 9–60). The
most frequent pathology was liposarcoma (n=6). Patients’ back-
grounds are summarized in Table 1. Chemotherapy consisted dox-
orubicin-based regimen. The mean time from surgery to the most
recent clinical follow-up was 111 months (range 66–197).
Free muscle transplantation
All patients underwent free muscle transplantation immediately
after resection of the tumors . The transferred muscles included
eight latissimus dorsi, two gracilis, and one tensor fascia lata. All
the transplants received neurorraphy of the motor nerve and were
used for reconstruction of knee extension and flexion in four pa-
tients each, ankle, and toe dorsiflexion in two, and shoulder flex-
ion in one (Table 1).
There were two complications associated with the procedure.
Venous thrombosis occurred in one patient receiving a latissimus
dorsi muscle. The muscle survived by an emergent reanastomosis
of the vein after excision of the thrombus. Skin flap necrosis of the
gracilis occurred in one patient due to an inadequate design of the
flap. The complication required a skin graft to close the wound.
The viability of the gracilis muscle, however, was sound. Thus all
the muscle transplants survived.
The patients were examined at approximately 1-month intervals.
During each visit clinical and electromyographic examinations of
the muscle were performed. Motor unit potential of the muscles
K. Ihara (
) · S. Sakamoto · S. Kawai
Department of Orthopedic Surgery,
Yamaguchi University School of Medicine,
1-1-1 Minamikogushi, Ube, 755-8505 Yamaguchi, Japan
Tel.: +81-836-222266, Fax: +81-836-222267
Eur J Plast Surg (2003) 26:198–201
Koichiro Ihara · Sohtetsu Sakamoto · Shinya Kawai
Computed tomography to evaluate postoperative changes
in free functioning muscle
Received: 14 October 2002 / Accepted: 10 March 2003 / Published online: 30 April 2003
© Springer-Verlag 2003