In our unit, chronic SCI patients are referred from all parts of Sweden and from other European countries for reconstructive hand surgery. The patient is evaluated prior to surgery by the team consisting of hand surgeon, neurologist, physical and occupational therapists. In addition to the traditional preoperative assessment of of muscle strength, joint range of motion and sensibility, the individual evaluation also includes bladder and bowel function, pain assessment, spasticity, ongoing infections and autonomic dysreflexia. Preoperative treatment of spasticity might 
include botulinum toxin injections or oral medication. The wish and need to become independent in bladder and bowel care is incorporated. The risk of reactivation of psychological crisis reaction is evaluated. Special attention is given to detect and deal with factors that may directly affect the outcome of surgery, e.g., general physical status, wheelchair maneuvering technique, catheterization strategies and pressure sores.In year 2010, 36 patients underwent reconstructive tetraplegia hand surgery in our unit. All of these patients had extensive preoperative evaluation including the factors listed above. Not only were all patients operated according to schedule but they were also able to fully comply with the early active training protocol after surgery. Short-term evaluation of patient satisfaction of outcome was high or very high.
Physical and psychological preparations are necessary for optimal outcome. We conclude that consistent involvement of SCI neurologist in the hand surgery team plays a key role in the improved functional results after surgery observed the recent years.
