title: A single-stage operation for reconstruction of hand flexion, extension, and intrinsic function in tetraplegia: the alphabet procedure.
abstract: Surgical reconstruction is an established method to restore grip and grasp function after traumatic cervical spinal cord injury and tetraplegia. It can offer the patient improved ability to perform activities of daily living. Traditionally, surgical reconstruction of hand function has required separate operations for flexors and extensors. Here, we present a combination of procedures that provides key pinch and finger flexion together with opening of hand as a 1-stage operation. This reconstruction includes 7 individual operations that are performed in the following order: (1) split flexor pollicis longus-extensor pollicis longus distal thumb tenodesis, (2) reconstruction of passive interossei, (3) thumb CMC arthrodesis (4) brachioradialis-flexor pollicis longus tendon transfer, (5) extensor carpi radialis longus-flexor digitorum profundus tendon transfer, (6) EPL tenodesis, and (7) extensor carpi ulnaris tenodesis. We have chosen to entitle this reconstruction the alphabet or ABCDEFG procedure, an abbreviation for Advanced Balanced Combined Digital Extensor Flexor Grip reconstruction. To reduce the risk of adhesions after this extensive surgery and to facilitate relearning the activation of transferred muscles with new functions, early active training is performed. It is concluded that this 1-stage combination of operations can reliably provide grip, grasp, and release function in persons with C6 tetraplegia, patient satisfaction is high, time and effort for patient and caregivers are less, and incidence of complications is comparable with other published treatment modalities.
authors: National Center of Reconstructive Hand Surgery in Tetraplegia, Department of Hand Surgery, Sahlgrenska University Hospital, Göteborg, Sweden. jan.friden@orthop.gu.se
authors: Jan
authors: J
authors: Fridén
authors: Carina
authors: C
authors: Reinholdt
authors: István
authors: I
authors: Turcsányii
authors: Andreas
authors: A
authors: Gohritz
mesh_terms: D000203:Activities of Daily Living; D001174:Arthrodesis / Q000379:methods; D006225:Hand / Q000503:physiopathology / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000517:prevention & control; D011782:Quadriplegia / Q000503:physiopathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013709:Tendon Transfer / Q000379:methods; D053656:Tenodesis / Q000379:methods; D013933:Thumb / Q000503:physiopathology / Q000601:surgery; D000267:Tissue Adhesions / Q000517:prevention & control; D016896:Treatment Outcome