Current concepts in reconstruction of hand function in tetraplegia

Several recent developments in the field of reconstructive hand surgery in tetraplegia have created a foundation for further refinements of both surgical techniques and postoperative training strategies to improve the outcome of restoration of upper extremity functions. A remarkable means of improving function is the immediate activation of transferred muscle after surgery. Early active training of new motors not only prevents the formation of adhesions but facilitates the voluntary recruitment of motors powering new functions before swelling and immobilization-induced stiffness restrain muscle contractions. A common observation internationally over the past years is that the number of incomplete tetraplegics increases. This shift towards more incomplete injuries with spasticity as a common feature in addition to the paralysis has expanded and changed the spectrum of surgeries in this group of patients and also emphasizes the need for a revisit and further development of the different strategies for reconstruction of hand function.