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Figure 1. Clinical images of functional upper limb reconstruction with a combination of free functioning muscle transfer and nerve transfer in an 83-year-old patient. A: right arm defect following sarcoma excision including 100% of biceps and over 50% of brachialis, which was denervated. This was reconstructed with a free innervated gracillis myocutaneous flap with the nerve coaptated to the cut end of the musculocutaneous nerve, along with a flexor carpi ulnaris branch to brachialis branch nerve transfer; B: results after 12 months, demonstrating very good cosmesis and contour; C, D: active elbow flexion from 110° to 40° with M4 power (see Video 1)