Methods. We studied two children who underwent free gracilis transfer to restore digital flexion after VIC, one neonatal (Patient A) and the other following supracondylar humeral fracture (Patient B). Age at operation was 22 (A) and 47 (B) months, with eight and ten years’ follow-up, respectively. Magnetic resonance imaging (MRI) scans were conducted to compare the cross-sectional area, volume, and quality of the transferred muscle to the in-situ gracilis muscle. Forearm length (clinical and radiographic), sensibility, pinch/grip strength and dexterity (modified Percival score), facility with activities of daily living (ADL—WeeFIM score), and subjective satisfaction with the procedure (analog scale) were measured.

Results. The involved forearm was shorter by 7% (Patient A) and 5% (Patient B). By MRI, the transferred muscles in both patients had normal signal quality, cross-sectional areas, and volumes. Moving 2-point-discrimination was 2-3 mm (Patient A) and 3-4 mm (Patient B). Semmes Weinstein testing was normal (5) in both patients. Compared to the opposite hand, key and tip pinch strength were 50% and 43% respectively (Patient A) and 53% and 73% respectively (Patient B); grip strength was 50% (Patient A) and 67% (Patient B). Passive digital flexion equaled active flexion in Patient B but exceeded it in Patient A by 44%. Both patients scored 7/7 in all categories of the modified WeeFIM except for residual difficulty with buttons and cutting meat (6/7). Compared to the opposite hand, the Moberg pickup test was 86% slower in Patient A and 35% slower in Patient B. The modified Percival scores were 18/20 (Patient A) and 20/20 (Patient B). Subjectively, Patient A rated his satisfaction as 4/5; his parents rated function as 3/5 and aesthetics as 4/5. Both Patient B and his parents rated aesthetics as 2.5/5 and function as 5/5.

Conclusions. MRI demonstrated that these transferred gracilis muscles remained healthy. Useful hand function was restored in both patients, approaching independence in ADLs. Patient B demonstrated that near-normal function can be restored. To our knowledge, we report the longest follow-up on a young child undergoing FFMT and the first data on qualitative and quantitative MRI evaluation of the transferred muscle in pediatric patients. These data support free gracilis transfer in the reconstruction of VIC even in very young children.