A 25-year-old with total brachial plexus avulsion undergoes staged reconstruction in which a functioning free muscle transfer is performed to restore finger flexion, followed later by a second free muscle for finger extension. Which muscle is classically used as the free transfer in this double free muscle procedure?

• A Latissimus dorsi
• B Trapezius
• C Rectus femoris
• D Gracilis ✓

Explanation

The Doi double free muscle transfer uses the gracilis because of its long tendinous portions, reliable vascular pedicle, and single nerve supply suited to microvascular transfer. The first stage restores elbow flexion coupled with finger extension, and the second stage restores finger flexion, typically driven by intercostal or spinal accessory nerves. Latissimus dorsi and rectus femoris lack the suitable tendon architecture for this role.

Reference: Campbell's Operative Orthopaedics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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