In 2005, it was decided that all adult persons living with tetraplegia in Iceland should be offered assessment for possible surgical reconstruction of hand function. Dr. Páll Ingvarsson (photo to left), senior consultant at Grensás Hospital in Reykjavik, initiated an extensive project to make this happen. Sahlgrenska University Hospital in Göteborg, Sweden was entrusted the task to provide and develop an outreach plan for Icelandic patients as well as collaborate, train and interact with rehab expertise in Iceland. Five years later, 15 reconstructions have been performed and all patients who chose to have an assessment, have in fact been assessed, and about one third of them have had surgery. Six individuals are scheduled for future reconstructions. Despite the distance but thanks to enthusiastic doctors, physiotherapists, occupational therapists and other personnel this project proved successful and worthwhile. The operated persons score very high on satisfaction and performance after surgery and rehabilitation relative to their preoperative priority goals. The Icelandic example may serve as model for small countries to provide up-to-date reconstruction surgery in this field. More information about the Icelandic project can be obtained from Dr. Páll Ingvarsson (palling@landspitali.is).