Since the early 1970s, the feasibility of transferring a muscle and having it survive and eventually function has been demonstrated both in research laboratories and clinically. Over a decade later, the factors influencing success are better understood. There have been significant contributions in concepts of muscle anatomy, muscle physiology, muscle reinnervation, and muscle's response to ischemia. Ischemia time, within reason, does not appear to be as influential as first thought. The potential for demonstrating the efficacy of postoperative exercise is but one of the areas that could benefit from further research endeavors.