The main objective of this retrospective study was to evaluate the long-term functional outcome in patients treated for Volkmann's ischemic contracture. In this study, functional outcome (measured as mobility, grip strength, and sensibility) and arm length difference after treatment of Volkmann's ischemic contracture were analyzed and discussed. Twenty-five patients treated between 1969 and 2001 were evaluated. The method of treatment was related to the severity of the infarction, ranging from conservative to free vascularized muscle transplantation. Although the study population was small, we could observe a wide range of functional outcome. Substantial improvement of function was obtained in patients who had free vascularized muscle transplantation. Unfortunately in one patient with an occlusion of the distal brachial artery and an insufficient flow through the collateral circulation of the radial artery, the gracilis muscle was lost. Tendon lengthening had unsatisfactory results because of recurrence of the contracture. Excision of fibrotic muscle tissue, neurolysis and tenolysis sometimes combined with a tendon transfer gave good hand function results in patients with sufficient remaining muscle tissue. In most of the patients in whom the contracture developed during childhood, a difference in forearm length was observed.