Reconstructive surgery for permanent palsy of the median nerve

Permanent palsies of the median nerve cause severe impairment of hand functions. This chapter reviews both the various surgical methods able to restore functions and complex mechanisms necessary for brain adaptation to the new functions of the cortical areas. Different methods of reconstructive surgery, according to both the severity of palsy and patients' needs, are presented. The contemporary restoration of sensory function of the paralysed digits is recommended, as sensation is a prerequisite for good motor function. The various mechanisms and methods useful to obtain good gliding and strength of the transferred tendons are stressed. Reconstructive surgery for permanent palsy of the median nerve can supply improved function, provided that all the recommendations for a meticulous balance of the number of functions to be restored and available motors to be transferred, as well as of their strength and course, are addressed.