Active pinch and grasp restoration for tetraplegian. The procedure begins with isolation of the anatomic components necessary for transfer. The radial sensory nerve, brachioradialis, extensor carpi radialis longus, and outcropping muscles are clearly delineated. The brachioradialis is harvested from its insertion into the radial styloid. A freer is used to protect the surrounding neurovascular bundles. The tendon is released and the muscle tendon unit is mobilized well proximal into the form to increase its excursion. The radial sensory nerve and radial artery must be identified and protected. Next, the extensor carpi radialis longus is harvested. Atlas clamps are placed around the tendon, both proximal and distal to the outcropping muscles. The tendon is released by sharp dissection. The tendon is then passed beneath the third compartment in preparation of transfer. Subsequently, the recipient FPL and FDP tendons are isolated. Vest loops are placed around the FPL and FDP tendons. Transformation by traction is easily seen. The FDP tendons are sutured in mass to allow for appropriate cascade function. The goal is to establish a slightly reverse cascade to ensure adequate index finger flexion for lateral pinch function. Next, the extensor carpi radialis longus is woven through the flexor dudentorum profundus tendons. A pulvertaft weave is used along with a tendon braider. One must ensure that all tendons are included in the weave process. Typically, a strong coaptation is obtained between the extensor carpi radialis longus and the flexor dudentorum profundus tendons. The braker radialis is then passed through the flexor pollicis longus tendon. A similar pulvertaft weave is utilized. Often, this repair must be augmented by additional sutures to enhance the repair.

pinch restoration

grasp restoration

tetraplegians

anatomic components transfer

reverse cascade