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• W4248025788 abstract "We very much appreciate the letter from Lim and colleagues. First, we would like to say that we have read their work with great interest over the years, especially with regard to the use of the flexor carpi ulnaris (FCU) as a donor muscle in tendon transfers. Indeed, it was their preliminary report,1Lim A.Y. Kumar V.P. Pereira B.P. Hua J. Independent function in a tendon transfer of the split flexor carpi ulnaris.Plast Reconstr Surg. 1999; 104: 1739-1741Crossref PubMed Scopus (14) Google Scholar in part, that provoked us to take a closer look at the FCU as a donor muscle after we had performed our initial survey study.2Lieber R.L. Fazeli B.M. Botte M.J. Architecture of selected wrist flexor and extensor muscles.J Hand Surg. 1990; 15A: 244-250Abstract Full Text PDF Scopus (213) Google Scholar In response to their 2 points we would first like to say that the issue of the “2 heads” of the FCU may be one of semantics. There is no question that the FCU origin has an ulnar and radial component but we did not consider them to be distinct “heads” as is the case, for example, with the pronator teres. We would like to state simply that in our hands the FCU is not divided easily along the distal tendon axis, and thus we would not be inclined to separate it and use it as a separate donor muscle. We do not dispute that the muscle can be divided using sharp dissection. This being said, the main issue is whether the different FCU components are separable naturally and whether they can function independently. The authors have shown that the 2 FCU components can generate isometric force but this is nowhere near the level of evidence required to state that they are “functional” when separated. The fact that they still have a common origin and that there is tremendous intramuscular force transmission3Street S.F. Lateral transmission of tension in frog myofibers a myofibrillar network and transverse cytoskeletal connections are possible transmitters.J Cell Physiol. 1983; 114: 346-364Crossref PubMed Scopus (324) Google Scholar almost guarantees that one muscle component would “drag” or “be dragged” by the other component when any movement was required. In addition, despite the distinct innervation of the different FCU muscle portions, there is no evidence that similar, dually innervated muscles can be controlled independently.4Bodine S.C. Roy R.R. Meadows D.A. Zernicke R.F. Sacks R.D. Fournier M. Edgerton V.R. Architectural, histochemical, and contractile characteristics of a unique biarticular muscle the cat semitendinosus.J Neurophysiol. 1982; 48: 192-201PubMed Google Scholar It would require a tremendous leap of faith to believe that these branches could ever be under the disparate motor control patterns that would be required for distinct function. Finally, with regard to the FCU being a “type IIB muscle,” it is our premise that there is no such thing as a type IIB muscle fiber in human skeletal muscle. It now has been shown clearly that although the 3 fast myosin heavy chain genes (type IIA, type IIX, type IIB) exist in humans, only type IIA and type IIX fibers are expressed in human muscle.5Smerdu V. Karsch-Mizrachi I. Campione M. Leinwand L. Schiaffino S. Type IIx myosin heavy chain transcripts are expressed in type IIb fibers of human skeletal muscle.Am J Physiol. 1994; 267: C1723-C1728PubMed Google Scholar The other point regarding fiber type is that we do not believe fiber type plays much of a role in determining either the quality, function, or choice of muscle as a donor for tendon transfer. Skeletal muscle architecture is by far the dominant factor.6Burkholder T.J. Fingado B. Baron S. Lieber R.L. Relationship between muscle fiber types and sizes and muscle architectural properties in the mouse hindlimb.J Morphol. 1994; 220: 1-14Crossref Scopus (15) Google Scholar, 7Lieber R.L. Fridén J. Functional and clinical significance of skeletal muscle architecture.Muscle Nerve. 2000; 23: 1647-1666Crossref PubMed Scopus (802) Google Scholar Thank you for the opportunity to respond to this letter. We offer this response in the spirit of improving all of our understandings of upper-extremity muscle design. FCU AnatomyJournal of Hand SurgeryVol. 30Issue 4PreviewWe read with great interest the article by Fridén J et al (J Hand Surg 2004;29A:909–914) and would like to congratulate the authors on their work. We would like to comment, however, on the following statements by the authors that quote our work as a reference (reference no. 19): Full-Text PDF" @default.
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