Sunday, October 24, 2010

Full Reconstruction of Hand Function in One Stage

Although the postoperative training is demanding, the one-stage reconstruction of hand function in tetraplegia proves a successful operation with predictable result. With nearly 5 years of experience with this type of reconstruction, that covers the basic needs of hand control, has not only saved one extra operation for the patient but also greatly reduced the total time of rehabilitation. The outcome is generally better than the operations made in two steps (separate flexor and extensor reconstructions). The boxes above demonstrate the 7 different procedures comprised in this reconstruction. Thumb flexion and finger flexion functions are restored by active transfers. Remaining procedures are tendon tensionings (tenodeses) that are controlled by joint motions, for example wrist flexion. The basis of the thumb is fused to secure both a good contact against index finger when flexing the thumb and sufficient opening when wrist if flexed by gravity or by active motion. Picture to the left shows how patient operates computer mouse 4 weeks after the combined one-stage operation.

Posted by Jan Fridén and Carina Reinholdt