Midcervical tetraplegia with strong wrist extension: a two-stage synergistic reconstruction of the hand.

Reconstructive surgery can restore appreciable function of the upper limb in tetraplegic patients. The magnitude of the function regained depends on several factors: (1) the level of the spinal cord lesion, (2) careful patient selection, (3) thoughtful application of the basic principles of tendon transfer, (4) absence of severe spasticity, (5) the remaining sensory function of the hand, and (6) the surgical program and the surgeon's expertise with this type of patient. Reconstructive surgery offers patients not only greater physical independence but also psychological benefits. This article refers to cases with midcervical spinal cord lesion where wrist extension is complete and strong (MRC grading 5). It describes the author's strategy and technical choices in these patients, based on an ever evolving experience of more than 30 years.