While downhill skiing, a 19-year-old man collided with a steel tower, sustaining traumatic dissection of the aorta, bilateral pulmonary contusions, and fractures of the right femoral neck and left humeral neck. He was treated conservatively in the intensive care unit under continuous sedation for 9 days. After osteosynthesis of the fractures, his left hand was completely paralyzed. He was referred to our institution, where we diagnosed severe Volkmann’s contracture. Five months after his accident, we performed neurolysis of the median and ulnar nerves, flexor tenotomy, and flexor-muscle sliding operation. One year after these procedures, we restored flexion of his four fingers by free functional gracilis muscle transfer and that of the thumb by brachioradialis muscle tendon transfer. Two years and 10 months after surgery, finger flexion was sufficient to assist in performing activities of daily living. For severe Volkmann’s contracture involving the total loss of finger flexion and partial loss of finger extension, free functional gracilis muscle transfer can effectively restore the range of motion, although the procedure is technically demanding, given the requirements of a reliable donor nerve and limited ischemic time.
