Reach out and grasp the opportunity: reconstructive hand surgery in tetraplegia

Jan Fridén*, Richard L. Lieber

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)343-353
Number of pages11
JournalJournal of Hand Surgery: European Volume
Volume44
Issue number4
DOIs
StatePublished - May 1 2019

Keywords

  • Spinal cord injury
  • muscle-tendon-joint mechanics
  • outcomes
  • single-stage operation
  • tetraplegia
  • upper limb reconstructive surgery

ASJC Scopus subject areas

  • Surgery

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