> NOTTWIL Tetrahand Reconstruction of Hand Function – for a better outcome

Reconstruction of Hand Function

Grasp and release!

Reconstruction of hand function needs an individual plan for every patient. It is not the functional improvement from the surgeon’s or the therapist’s perspective that is important but demands from the patient to be able to control as many as possible of the daily routines of life.

Hand reconstruction can be performed by nerve and/or tendon transfers.

Nerve transfer

Nerve transfers can restore: 

  • wrist extension (pulling up the wrist)
  • opening fingers and thumb
  • closing fingers and thumb around an object

Requirements
To be suitable for nerve transfer, you need to have at least one expendable donor nerve, which is likely in C5-C7 complete or incomplete spinal cord injury.

What does the surgery involve?
In nerve transfer surgery, the functioning donor nerve is exposed, cut and sutured to the non-functioning nerve. Surgery is done under loop or microscope magnification.

What happens after surgery?
Usually, no splint is needed after surgery. Instruction from the therapist is given for self-training.
The duration of hospital stay is 2-3 weeks.

What outcome can be expected?
The success of surgery will depend on the level of injury, the time since injury and the flexibility of the joints. Recovery is slow as the nerve takes time to grow down to the muscle. You will not see any signs of muscle action of the previously paralyzed muscle before 5-9 months after surgery and it will take more than 1 year to strengthen the muscle. Outcomes after nerve transfers are less consistent compared to tendon transfers.

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Schematic image of a nerve transfer

Tendon transfer

With tendon transfers, the following functions can be restored:

  • finger flexion
  • thumb flexion
  • hand opening and 
  • finger balancing

Usually, several tendon transfers are combined to achieve hand function in one single operation. 

Requirements
To be suitable for this type of reconstruction, you need to have at least one, preferably two donor motors, which is likely in C5-7 complete or incomplete spinal cord injury. Good donor muscles are the brachioradialis muscle (one of the elbow flexors) and the extensor carpi radialis longus muscle (one of the wrist extensors).  

Tendon transfer surgery can be done at any time after the injury.

What does the surgery involve?
In tendon transfer surgery, tendons from functioning muscles are detached, re-routed and sutured to tendons of non-functioning muscles.

In addition to the tendon transfers, some other surgical procedures may be necessary such as fusion of the thumb saddle joint.

What happens after surgery?
After the operation, a splint is needed for 6 weeks. The splints are continuously adapted by time. Activation of the new functions by active training under supervision of the therapists starts at day one after the operation and the training takes place 4 times a day. Together with the hand therapists you learn to control the newly reconstructed muscle functions, to use the new hand function in everyday life and to strengthen your muscles.

The duration of hospital stay is 5-6 weeks.

What outcome can be expected? 
Grip reconstruction by tendon transfer are a very reliable procedure to improve your hand function. 

In a nerve transfer, a functioning nerve (donor nerve) is cut a rewired with a non-functioning nerve (recipient nerve).

After a nerve transfer, it takes several months up to a more than a year until a new muscle function will recover, because the nerve has to re-grow down to the muscle.

Nerve transfers should ideally be performed within one year after the accident, since later the muscle may not be responsive any more.

Our most commonly used nerve transfers restore finger and thumb extension and flexion.

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Schematic image of a tendon transfer

a littleis a lot

Tetrahand Surgery

Hand and Tetrahand Surgery

Contact
Swiss Paraplegic Centre
Guido A. Zäch-Strasse 1
CH-6207 Nottwil
E-Mail | T +41 41 939 52 00

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