Launching a new national tetraplegia upper extremity surgery service.

Abstract

OBJECTIVE: Surgical restoration of upper extremity function in tetraplegia is acknowledged as beneficial, yet in many countries it is underused or absent. This study describes a 10-year review of a project to implement a tetraplegia upper extremity surgery service in Hungary. The main aims were to increase awareness among patients, the medical community and the public about the benefits of this rehabilitation. The process of implementing a national tetraplegia hand surgery service is described, together with a retrospective outcome study of upper extremity function after surgical reconstruction in this service. METHODS: A total of 141 tetraplegic patients were assessed. Of these, 57 (40%) underwent a total of 126 reconstructions, including 366 procedures, between 2002 and 2012. Clinical parameters and patient-perceived results demonstrated improved functions and abilities. Considerable media attention and scientific presentations facilitated making this service permanent. In 2009, surgical rehabilitation in tetraplegia became a recognized part of the rehabilitation protocol in Hungary. RESULTS: These results suggest that the success of starting a national tetraplegia hand service relies on convincing postoperative outcomes, patient-to-patient contacts, and co- operation between rehabilitation specialists, therapists, health authorities and surgeons. DISCUSSION: The leadership of dedicated hand surgeons is necessary to provide and disseminate scientific support for the concept of tetraplegia hand surgery and to stimulate interdisciplinary communication and educational programmes.