Evolution of surgery for tetraplegic hands in Japan

In Japan, reconstructive surgery for the tetraplegic hand has developed mainly with Tsuge, Yabe, and their students for a little more than 30 years. They mostly used Zancolli's classification and, consequently, followed his treatment guidelines. Some unique procedures and techniques, however, have been devised based on their own experiences, including a static opponens tenodesis using FCR tendon, a modified lasso procedure to anchor a paralyzed flexor superficialis tendon through A2 pulley rather than A1 pulley, one-stage reconstruction of both extensor and flexor tendons, and the percutaneous functional electrical stimulation (FES) system.