Use of flexor carpi ulnaris muscle creates pulley effect

The Mayo Clinic modified double gracilis functioning free muscle transfer (FFMT) uses the flexor carpi ulnaris muscle to create a pulley effect at the proximal forearm. Detaching the tendinous portion of the muscle distally, surgeons weave it through the anconeus and extensor tendons at the elbow's lateral aspect. They then pass the remaining tendon over the gracilis muscle to secure it to the medial epicondyle.