Wednesday, July 28, 2010

Some of surgeon's technical considerations - by Jan Fridén

Surgical tendon transfers involve the careful assessment of lost muscle function, or more often, a combination of lost functions. The assessments are quite challenging. They include intriguing functional measurements and very often, true control comparisons are not possible as the spinal cord injury or disease itself affects both sides. The surgeries themselves are also technically challenging, as there are many complicated real-time decisions to be made. During surgery there are several details that need to be addressed. For example, selection of donor muscles, positioning and orientation of donor muscles, tissue preparation, setting the tension of muscle-tendon units, balancing joints and performing reliable and durable sutures for the attachments of tendons. After operation, the surgeon needs to be directly involved in the rehabilitation as well as carefully communicating with occupational therapists and physiotherapists in postoperative patient care. It is, after all, only the responsible surgeon who knows the details of the surgical procedure performed. We are all aware of the fact that there are no shortcuts in our endeavor for perfection in the highly demanding and exquisite field of reconstructive tetraplegia hand surgery.