Muscle transplantation is a treatment option in reconstructive surgery. It is also known as muscle transfer. During the procedure, muscles are redirected to stabilize the joint or donor muscles are used. The procedure is a motor replacement operation and is often used in shoulder surgery following severe muscle injuries.
Muscle transplantation is intended to reduce pain and improve joint functionality. It is relatively complex and only indicated if other procedures have not been successful.
For a muscle transfer to be successful, the transferred muscle must be long enough and well supplied with blood.
The origins of muscle transplantation lie in surgical procedures on the broad back muscle(latissimus dorsi muscle) due to significant defects in the rotator cuff of the shoulder joint. Muscle transplantation offers considerable advantages here. This is why it has been used successfully and increasingly since 1988.
Due to its large surface area, this muscle allows sufficient mobility for the transfer. Healing of the transferred tendon is also relatively unproblematic.
Eight muscles are primarily responsible for the stability and functionality of the shoulder joint. They must work together precisely so that the shoulder is fully functional.
With the exception of the latissimus dorsi muscle, all the muscles of the shoulder joint begin at the shoulder girdle. Each shoulder muscle is responsible for an individual movement. The four muscles closest to the joint form the rotator cuff.
If one of these muscles does not function properly, the entire joint is less mobile and unstable. A muscle transfer is not always necessary, but in severe cases it may be the only option.
Most shoulder muscle tears are caused by wear and tear. The age-related, chronically narrowed space under the acromion and the genetically poor quality of tendon and muscle tissue favor such muscle tears.
Over time, the tendons and muscles slowly fray and the defects become larger and larger. Falls on the arm and shoulder or the one-sided strain experienced by throwing athletes also encourage muscle tears. They require both donor muscle and donor nerve.
In such severe cases, defects in the rotator cuff of the shoulder can no longer be reconstructed by suturing. In such cases, a muscle transplant can usually restore shoulder function well.
Muscle transplantation is performed when the torn tendon and the affected muscle have retracted to such an extent that fixation to the humeral head is no longer possible.

Under certain circumstances, it can be helpful to move a muscle to another location © adimas | AdobeStock
Ideally, the surgeons specialize in
specialized.
As a rule
can perform such operations. The procedures are often performed at specialist orthopaedic clinics and university hospitals with surgical centers.
Plastic surgeons are also involved in the microsurgical reconstruction of lesions on peripheral nerves. This means that they can also perform muscle and tendon transfers.
Two surgical methods for joint centering are standard:
- the L'Episcopo method and
- the Herzberg transfer.
Both achieve good functional results.
During the procedure, the patient usually lies on their side, but the operation can also be performed in a reclining position. During the first step at the top of the shoulder, the doctor exposes the rotator cuff and checks whether any defects can be closed. If this is still possible, a muscle transplant is unnecessary.
If not, the surgeon makes a second incision on the back of the shoulder and transfers the latissimus dorsi.
This operation is increasingly being performed with endoscopic assistance. The stress for the patient is considerably less as the tissue is spared.
The back muscle transfer (latissimus dorsi transfer)
Only pronounced defects in the rotator cuff justify such a major operation.
The surgeon detaches the latissimus dorsi muscle on the back of the upper arm and transfers it and its tendon to the back of the humeral head. In this way, the surgeon closes defects in the rotator cuff.
Instead of its previous function as an internal rotator, the muscle now acts as an external rotator.
Pectoral muscle transfer (pectoralis major transfer)
During the procedure, the pectoralis major muscle is transferred. This shoulder operation is necessary for orthopaedic and not plastic surgery reasons.
Theprerequisite for this operation is that
- the mobility of the shoulder joint is considerably restricted and
- a normal closure suture cannot repair the defect in the rotator cuff.
If the serratus anterior muscle is paralyzed, this is also an indication for a pectoralis major transfer. This muscle is located on the side wall of the rib cage and is often damaged in accidents or by tumors. Those affected can no longer stretch their arms properly or can only do boxing movements with severe pain.
During the operation, parts of the pectoralis major are detached and pulled backwards along the rib cage through the armpit. The surgeon then attaches the muscle to the outer edge of the shoulder blade.
Free functional muscle transfer (FFMT)
A free functional muscle transfer (FFMT) may be necessary if
- no donor muscle is available for the transfer or
- restoration of the nerve supply is no longer possible.
The following are suitable for such a muscle transfer
- the thigh muscle on the medial side, the gracilis muscle,
- the large back muscle latissimus dorsi and
- the straight thigh muscle at the front, the rectus femoris muscle.
The optimal choice of donor nerve is also important for the success of the operation and the post-operative recovery process.
As with any operation, there are surgical risks associated with anesthesia and wound healing. These include
- Thrombosis,
- bleeding,
- infections,
- nerve and vascular damage or
- embolisms.
The transplanted tendon can also tear or fail to heal properly. The risk is particularly high if the shoulder is loaded prematurely and incorrectly.
The attending physician accompanies the patient from preparation for the procedure through to comprehensive aftercare.
Six weeks of immobilization with a splint or plaster cast and subsequent physiotherapy are usual.
Passive physiotherapy exercises are recommended as early as one to two weeks after the operation. An active exercise phase then begins, as the muscle has to learn its new tasks.
From around twelve weeks, everyday activities are possible. Sports that strain the pectoral muscle may only be practiced after four to six months.
Recovery takes several months and always depends on the individual situation.