[Reconstructive surgery of the upper limbs in the rehabilitation of tetraplegia--case report].

As part of the rehabilitation of tetraplegic patients, movement improving operations have been carried out for more than 30 years. The scant results of the early 70's caused such a standstill and division among professionals, that operations on the upper limbs on tetraplegic patients became questionable. The authors started operating upper limb reconstructions on tetraplegia patients for achieving a basic hand function i.e. key pinch, grasping etc. in 2001. Three cases are quoted and one of them, operated ten months ago is described in details. The postoperative treatment of the other two patients has not finished yet. In 1998, a twenty-three years old girl had her fifth and sixth cervical vertebra broken in a car accident. The rugged break of the fifth vertebral body damaged the spinal chord. After the accident all four limbs became ataxic and a complete numbness occurred distally from the thoracic level of the chest. The patient went through a CV corpectomia, a corpus complementation, a CIV-V dissectomia and a CIV-VII ventrofixation. After the operation the movements of the upper limbs improved but those of the lower limbs did not. Her general condition stabilised after the treatments at the intensive care and the laryngological, the urological and the plastic surgery as well as the complex therapy at the rehabilitation department. She moved around in a wheelchair. After a para-coordinational treatment she was able to lift up small objects, but because of her paralysed bending and stretching finger muscles she was not able to hold heavier objects with her hands. In March 2002 a grip improving operation was carried on her dominant right hand. Twelve weeks after the operation she could lift up a weight of 2 kg and she was able to key pinch and grip with force.