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Local flaps, which can each provide 3--10 cm of soft tissue, block or perform skin grafts. Local flaps require an area of similar size, cut to shape, and the same level of elasticity [8]. This can be achieved with the use of plowing or undermining of the tissue to use in the required area [38]. The latissimus dorsi muscle and its thoracodorsal nerve are rated as the best donor muscles, providing eight to ten functional muscle units or eight percent of the strength of the original muscle [45] [48] [44]. A tailored transfer from this muscle would be more reliable than other options to assist with bracing or coverage [3]. Free functioning muscle transfers are a reconstructive option for severe and delayed nerve injuries based on the anatomical location of the reinnervated muscles [1] [2]. Such injuries include cases where both the nerve and muscle are injured due to either severe acute injury or changes from chronic axotomy and muscular fibrosis. The donor transferred from the muscle potentially provides a much greater degree of functional utility than the other local reconstructions with a similar volume of viable donor tissue available. As mentioned previously, nerve transfers restore function by transferring an intact (but less critical) nerve to a more critical nerve (usually Bz=distal, BA=proximal) using microsurgical anastomosis to recipient vessels [45]. The procedure is performed in an acute or delayed setting, depending on the availability and status of the recipient nerve, nerve transfer for reconstruction after upper extremity infections, venous stasis injuries, traumatic injuries, and malignant or nonmalignant diseases are common. In addition, small and large nerve grafts can be used to avoid sensory or motor nerve deficiencies. The donor nerve transfer can be used to restore a functioning muscle, nerve, tendon, or joint and is performed to reinnervate a muscle, tendon, joint, or a broken bone [43]. The Big Red One The Reconstruction (Special Edition) A temporal approach involves sequential supraperiosteal pedicle flaps based on the skin and soft tissue anatomy of the defect. The pedicles are then labeled and used as a template for pedicled recipient vessels and vessels outlined based on the transfers performed. The pedicle incision may then be extended based on the available recipient vessels to reconstruct the defect [46]. d2c66b5586