Open AccessReach out and grasp the opportunity: reconstructive hand surgery in tetraplegia
Author(s) -
Jan Fridén,
Richard L. Lieber
Publication year - 2019
Publication title -
journal of hand surgery. european volume
Language(s) - English
Resource type - Journals
eISSN - 2043-6289
pISSN - 1753-1934
DOI - 10.1177/1753193419827814
Subject(s) - medicine , tetraplegia , tendon transfer , tendon , grasp , rehabilitation , hand surgery , physical medicine and rehabilitation , surgery , reconstructive surgery , spinal cord injury , spinal cord , physical therapy , computer science , psychiatry , programming language
Reconstructive upper extremity surgeries in tetraplegia are technically challenging because of the many complicated real-time decisions that need to be made, e.g. extent of release of donor muscle-tendon complex, routing of donor muscles, tissue preparation and optimization, tensioning of muscle-tendon units, balancing joints and suturing tendon-to-tendon attachments. Nerve transfer surgeries can add functionality but also make the reconstruction planning more complex. In this overview, we present some of the fundamental muscle-tendon-joint mechanics studies that allow for single-stage surgical reconstruction of hand function as well as early postoperative activity-based training in patients with cervical spinal cord injuries. We foresee an increased need for studies addressing combined nerve and tendon transfer reconstructions in parallel with patient-perceived outcome investigations. These should be combined with implementation of assistive technology such as functional electrical stimulation for diagnostic, prognostic and training purposes.