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New Center for Advanced Reconstruction of Extremities (CARE) established at Sahlgrenska University Hospital

May 21, 2014, 5:31 am
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Interior of Ward
The Swedish Tetraplegia Hand Surgery service has changed setting.  It is now established in a modern and more adapted facility that better meet the patient demands of space and availability.  The ward is light with proximity to all necessary services i.e., occupational and physiotherapy, operation and recreational area.  Seven patient rooms will guarantee privacy as well as care in an attractive environment.  
Immediate Access to Park

Surgical Team
This new center also includes amputee patients undergoing orthopaedic osseo- integration. In the interface of  nerve transfer and targeted muscle innervation, the two subspecialities for treatment after loss of extremity functions will co-operate in a cross-professional and cross-scientific unit. 

On May 20th, the first tetraplegic patient was operated at this new center.  Tetrahand surgeons Jan Fridén and Carina Reinholdt together with assisting guest surgeon Francesca Toia from Palermo, Italy performed this operation - a complete grip reconstruction (photo left).

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Nordic Council sponsors Tetrahand Surgery Congress in Iceland

May 28, 2014, 11:09 pm
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Landspitalinn Main Hospital
The Nordic Council has acknowledged NORTH - Nordic Tetrahand Surgery and decided to sponsor our annual congress.  This year it will be held in Reykjavik, Iceland on June 12-13. The Nordic Council, which  was formed in 1952, is the official inter-parliamentary body in the Nordic Region. The Council has 87 elected members from Denmark, Finland, Iceland, Norway and Sweden as well as from the Faroe Islands, Greenland and Åland.  

 This year´s NORTH course will include for example the  topics: Tetraplegia in Iceland, Tips and tricks in Tetrahand surgery, Report from the European course in Nottwil, Salvage procedures, Grip reconstruction - it is never too late, Rehabilitation after surgery for spasticity and Complications to avoid. Local host in Iceland will be Dr Páll Ingvarsson. Venue: Hringsalur, Landspitali Hospital, Reykjavik. A site visit to Grensás Rehabilitation will be arranged for interested.

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In Commemoration of Dr. Paul Brand

June 3, 2014, 12:59 am
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Main Hospital Building CMCH, Vellore
It is truly a great honor and pleasure to hold the first triennial Dr. Paul Brand Memorial Oration, on September 5, 2014 in Vellore, India. Dr. Brand has impacted global hand surgery in general but specifically the hand surgeons performing tendon transfer surgery.

Dr. Paul Brand was born on July 17th, 1914 to a missionary couple (Jesse and Evelyn Brand) and grew up in the Kolli Hills of Tamil Nadu, India until he went to the Great Britain in 1923 for education.
Dr. Paul Brand
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 In 1946, he joined the staff of the Christian Medical College&Hospital in Vellore, India .  In 1950, with a donation from a missionary woman, Brand established the New Life Center, Vellore, as a model rehabilitation center. This helped dispel the stigma that was so prevalent even among medical professionals. Correcting deformities to restore the self-respect of patients and to integrate them into society was his cherished goal.

In 1966 and after 19 years of service in India, he moved to the United States to take up the position of Chief of Rehabilitation Branch at the National Hansen´s Disease Center at Carville, Louisiana. He worked there for 20 years and established a research unit to study the complications of insensitive hands and feet, their prevention and management.

Dr. Paul Brand was one of the main architects of the All-Africa Leprosy Rehabilitation and Training Center in Addis Ababa, Ethiopia., and the Schieffelin Leprosy Research and Training Center at Karigiri, India, in Vellore district.  Dr Paul Brand spent a lifetime working with people affected by leprosy, doing his utmost to destroy the stigma of the disease, and rebuild the lives of those destroyed by it. When he retired in 1986, he moved to Seattle  and continued his teaching work as emeritus professor of Orthopaedics at the University of Washington. 

From a hand surgery and hand therapy point of view, Dr Brand was probably most known for his hand mechanics "Bible"Clinical Mechanics of the Hand. Mosby, 1985.

Selected Literature
Paul Brand and Philip Yancey (1980). Fearfully and Wonderfully Made. Zondervan.
Paul Brand and Philip Yancey  (1983). In His Image. Zondervan.
Paul W. Brand (1985). Clinical Mechanics of the Hand. Mosby. 
Paul Brand and Philip Yancey (1993). Pain: The Gift Nobody Wants. Zondervan. republished in 1997 as The Gift of Pain.
Paul Brand (1993). The Forever Feast. Vine Books.

Jan Fridén
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Hands Up for Rolling Stones

June 5, 2014, 3:42 pm
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Gabriela (right) experienced many cheerful moments at the Rolling Stones "14 on Fire" concert in Zürich past weekend.  At her follow-up after bilateral reconstructions of Triceps function today, she demonstrated the joy and feeling of freedom that she experienced by being able to stretch out her arms in space and join the crowd´s accolades at the memorable Stones performance.  Triceps functions are usually described as important for driving manual wheelchair, reaching out in space and position the hand - typically mechanistic views surely crucial in daily life.  Cheering at Rolling Stones is yet another but nevertheless powerful dimension of regaining arm control after reconstructive upper limb surgery. Gabriela´s achievement is admirableand inspiring to many spinal cord injured persons considering surgical reconstruction.  Ambitious postoperative training has been one of keys of her success. Congratulations to Gabriela (and Rolling Stones).


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Nordic Tetrahand Surgery Units Meet in Reykjavik

June 18, 2014, 1:47 am
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Last week, the Tetrahand teams in all five nordic countries gathered at the 3rd annual NORTH (Nordic Tetrahand) meeting.  This year the conference was held in Reykjavik, Iceland. Not only is Icelandic nature overwhelmingly spectacular but its care of spinal cord injured persons is professional and well connected to other nordic units.  Dr Páll Ingvarsson from Grensáas Rehabilitation hospital reported how surgical and rehabilitation support from the Tetrahand clinic at Sahlgrenska University Hospital in Göteborg, Sweden has been instrumental for surgical reconstructions of  tetraplegic patients in Iceland.  Occupational therapist  Sigþrúður Loftsdóttir (left) presented a case report of the experience of the first patient sent to Sweden for reconstructions as well as the clinical outcomes of the surgeries performed on all Icelandic patients so far.  Overall, the data showed high degree of satisfaction and major benefits in performance of daily activities. Guest speaker this year was Dr Andreas Gohritz from Department of Plastic Surgery, Basel University Hospital and Swiss Paraplegic Centre in Nottwil, Switzerland. He summarized the current knowledge of Nerve Transfer Surgery in Tetraplegia. 

The Norwegian ambassador Dag Wernøe Holter invited all participants to a generous and highly appreciated  reception at the Norwegian Embassy in Reykjavik. 

Members of NORTH express gratitude to The Nordic Council for financial support to develop this network of experts. We also thank Dr Páll Ingvarsson and Professor Leiv Hove for excellent arrangements.
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Workshop on Surgical Management of Upper Extremity in Tetraplegia – State of the Art

September 3, 2014, 12:19 am
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The International Spinal Cord Society (ISCOS) held the annual scientific meeting in Maasricht in September 2014.  Multiple presentations, lectures and overviews covered important scientific progresses in several fields pertinent to the spinal cord injured patients' health and care.  This year, a workshop on the Surgical Management of Upper Extremity in Tetraplegia, was given for the first time.  This workshop filled the lecture room more than well with professionals directly or indirectly involved in rehabilitation of hand function in tetraplegia.  The following aspects were included in the workshop:  Upper extremity management in tetraplegia, Reconstructive surgery - indications and possibilities,  Spasticity-reducing surgery,  Post-operative management and Future perspectives on reconstructive upper extremity treatment in tetraplegia. Drs Anand Nene, Govert Snoek, Carina Reinholdt, Johanna Wangdell and Jan Fridén gave their expert opinions and encouraged future communications through courses and networks.
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Extensive Exposure and Interest of Tetrahand Surgery at Asian Pacific Federation of Societies for Surgery of the Hand (APFSSH) Triennial Congress

October 5, 2014, 1:20 pm
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Kuala Lumpur, Malaysia, hosted the 2014 triennial APFSSH congress in October.  This well-organized meeting attracted many participants and several authorities in hand surgery.  A novel attention was paid on the relatively under-utilized field of tetraplegia hand surgery. Hence, Professors Caroline Leclercq and Jan Fridén had a "Meet the Experts" session about strategies for reconstruction.  They demonstrated clinical assessments live on spinal cord injured patients with tetraplegia and gave their expert opinions on how to improve hand function.  Further, Jan Fridén gave an invited lecture on "Upper Limb Reconstructive Surgery in Tetraplegia" and another lecture on "Tendon Transfer Surgery". Taken together this congress gave a boost to the awareness of the opportunities to restore hand control in tetraplegic individuals.
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Tetrahand Surgery Theme at Spanish Paraplegic Society Congress

October 12, 2014, 12:50 pm
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The Spanish Paraplegic Society held the annual congress this time in the city of Oviedo, Asturia. Tetraplegia hand surgery had its own session and Professor Jan Fridén was invited to deliver a keynote address about "State of the Art in Tetrahand Surgery".  After the presentation, plenty of timewas spent on discussing the when, where and how the surgical reconstruction strategies should be implemented.  It was agreed that this type of service should be integrated as a normal part of the rehabilitation after spinal cord injury and that information to the patient should be  provided during the primary rehabilitation period.
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German Congress for Orthopaedics and Traumatology

November 1, 2014, 12:16 am
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The German-speaking Speaking Society of Paraplegia arranged a session about "The Tetraplegic Hand" organized by Dr Doris Maier (Murnau) and chaired by Dr Richarda Böttcher (Berlin) at the DKOU congress in Berlin 28-31 October 2014. The following topics were addressed: "Assessment of Hand Function in Tetraplegia "(Martina Geuther), "Loss and Restoration of Hand Function" (Diana Sigrist-Nix), "Opportunities with Tetraplegia Hand Surgery" (Jan Fridén) and  "Loss of Hand Function - What can Technology offer?" (Rüdiger Rupp). This session covered a large spectrum of recent advances research frontiers ranging from assessment, evalation, nerve and tendon transfer surgery to neuro-engineering. In connection with this congress, Drs Jan Fridén and Andreas Gohritz published an overview of the tetrahand surgery field: Fridén J, Gohritz A. Rekonstruktion der Arm- und Handfunktion bei Halsrückenmarklähmung, Chir All 15:595-605, 2014.



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Surgical denervation for joint arthritis in spinal cord injured patients – small incisions for great pain relief

December 11, 2014, 6:19 am
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Patients with para- or tetraplegia frequently suffer from painful arthrosis, especially in their upper extremity due to heavy load during wheel-chair driving and transfers. However, frequently used bony procedures, such as fusions (arthrodesis), arthroplasty or joint implants have great disadvantages for this population, as they require long post-operative immobilization or severely restrict joint mobility which is a prerequisite for using manual wheel-chairs.
Surgical denervation means selective transection of nerve fibers transmitting pain from the joint to the brain which leads to significant reduction of pain symptoms. Joint integrity, skin sensitivity and motor innervation remains unaffected. No implants, postoperative rehabilitation or immobilization is required and early functional training is possible. All more invasive procedures, if needed in future, remain feasible.
This technique requires thorough anatomical knowledge and meticulous surgical technique. Since its introduction in the 1960ies, initial success rates of 80% or more have been reported for wrist but also in other joints, such as the shoulder, elbow, hand (finger and thumb) or the lower extremity (knee and ankle) have been successfully treated with this technique.
The effect of the operation can be predicted pre-operatively by temporarily blocking the nerves responsible for the respective joint by local anaesthesia.


In patients with spinal cord injuries, the method has been introduced recently at the Swiss Paraplegia Center in Nottwil by Dr. Andreas Gohritz. The incisions are small as depicted in the schematic picture, but great relief is possible, above all in painful wrists and thumb carpo-metacarpal (basis of the thumb) joints.
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Nordic Therapist Meeting on Tetraplegia Upper Limb Surgery

December 12, 2014, 2:55 am
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Therapists from Denmark, Finland, Iceland, Norway and Sweden met in Gothenburg in the end of November. During three intensive days we discussed, learned from each other and tried to reach consensus upon rehabilitation after reconstructive upper limb surgery. We had detailed discussions about outcome measures and rehabilitation strategies for triceps reconstructions, grip reconstructions and surgery for spasticity-induced deformities. Each country described the rehabilitation strategies today and Jette Skyggebjergfrom Denmark gave us a short report from the recently published article about long term follow up on the surgeries performed in Denmark. We also visited a training session with a patient two days after grip reconstruction.  At the end of this brief summit, a first version of Nordic guidelines for rehabilitation after tetraplegia upper limb surgery was agreed upon.  Each unit will discuss this initial version and further work will be done during the next NORTH-meeting that will be hosted in Denmark in September 2015. The meeting did however not only include hard work. During the evenings we had social activities including dining, singing, boat trip and sauna including bath in the 7°C “warm” ocean! We got to know each other more and are looking forward to future cooperation between our countries.
Finally, we would like to extend a special thanks to Professor Leiv Hove in Bergen, Norway and the Nordic Council for financial support that made this meeting both memorable and fruitful.

Johanna Wangdell, Anna-Karin Gustavsson & Lina Bunketorp- Käll

Participants shown in picture: Island: Sigþrúður (Sissu) Loftsdóttir, Sunna Kristinsdóttir. Finland: Leena Mäntylä, Pia Nahi. Denmark: Susanne Berner Nielsen, Jette Skyggebjerg. Norway: Anett Myhre Kallevik, Elin Widegren Norum. Sweden: Johanna Wangdell, Anna-Karin Gustavsson, Lina Bunketorp- Käll

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South African Society for Surgery of the Hand Refresher Course

February 23, 2015, 2:54 pm
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South African Society for Surgery of the Hand arranged their annual refresher course in Johannesburg in the end of February. Topics included this year were:

ANATOMY AND BIOMECHANICS CONGENITAL ABNORMALITIES
CP, STROKE AND BRAIN INJURY TETRAPLEGIA
TENDON TRANSFERS

Invited speakers were Drs Donald Sammut, UK and Jan Fridén, Sweden. Dr Sammut covered the complicated anatomy and biomechanics of the hand in a most fascinating way. Using didactic drawings and animations, the 3-D perspectives and the deformities caused by simulated paralyses became comprehensible. Brachial plexus and peripheral nerve injuries were taught in step by step assessment/treatment style with the presenters´ personal recommendations. Dr Fridén gave overview lectures about tendon transfer surgery, tetraplegia, brain and peripheral nerve injuries. Prof. Hans Myburgh reported the "South African tetraplegia surgery experience so far and the way forward" and Ms Melanie Skeen presented program for "Rehabilitation of the Tetraplegic Patient. The outcomes demonstrated clear improvements of functions, performance and satisfaction after surgery

Plenty of time was given for discussions at this highly appreciated and well-organized Refresher course.

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Grand Opening of Centre for Advanced Reconstruction of Extremities at Sahlgrenska University Hospital

May 22, 2015, 2:41 am
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Using his robotic arm, Magnus Niska cuts the symbolic band

A highly anticipated and much wanted dream came true when C.A.R.E., "Centre for Advanced Reconstruction of Extremities", was officially opened on May 22nd.  More than 150 patients and visitors attended the event. 
Filip Andersson demonstrates his hand skills after reconstruction
Vice Chair of Sahlgrenska University Hospital, Professor Lars Grip spoke to the audience. Lars Grip said: "This is day of completion of a deliberate effort by the Hospital and Academy to merge two highly specialized branches of hand and orthopaedic surgery to the benefit of our patients. They will be welcomed to an integrated, translational, research-intensive, modern and patient-friendly facility. We have high expectations that this new unit will allow development of advanced reconstructions in patients with paralyses of extremities or amputations after injuries and diseases".  Targeted muscle innervation, nerve and tendon transfer techniques, osseo-integration of brain-governed robotic arms and skilled personnel for rehabilitation will guarantee development and expert treatment at many levels. According to Dr. Carina Reinholdt, chair of C.A.R.E., patients with needs for assessment and treatment after cervical spinal cord injuries, brain injury with spasticity, plexus injuries and other peripheral nerve injuries as well as amputations are welcome to this new unit. "I also want to stress that patients from other countries outside Sweden may be referred to us", said Dr. Reinholdt.

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World-Wide Internet Distribution of “Update on Hand Surgery in Tetraplegia” in IFSSH-Ezine

May 2, 2015, 6:16 am
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A 14 page digital report of the committee of nerve and spinal cord injury (chaired by Ann Nachemson, Sweden) on current practice of hand surgery in spinal cord injury was published by the International Federation of Societies of Surgery of the Hand (IFSSH). The authors were Jan Fridén and Andreas Gohritz. The article is in 2 parts, the first included principles (definition, clinical outcomes, current utilization) and a second part on operative techniques, above all tendon and nerve transfer, to restore elbow and wrist extension, forearm pronation, hand grip and opening intrinsic function and reduce spasticity.
The IFSSH Ezine, a digital publication available to the global Hand Surgery and Hand Therapy communities free of charge. It has been established with the purpose of uniting the global hand surgery community and is intended to be a publication for IFSSH members, by IFSSH members.
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Grand Rounds Presentation at Rehabilitation Institute of Chicago

May 15, 2015, 6:00 am
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The Rehabilitation Institute of Chicago (RIC) invited Jan Fridén on May 13-14th, 2015 to give a presentation during „Grand Rounds“ on modern strategies of “Upper Extremity Surgical Rehabilitation in Tetraplegia“. He was invited by Prof. Richard L. Lieber (photo) who was recently selected as the new Chief Scientist and Senior Vice President of Research. The RIC is recognized since more than 20 years as the nation`s highest ranked provider of physical medicine and comprehensive rehabilitation and operates the largest rehabilitation research enterprise in the world. Special areas of its innovative applied research and discovery programs include spinal cord injury, stroke, traumatic brain injury, neurological rehabilitation, outcomes research, pediatric orthopedics and bionic extremity reconstruction.
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“Trinational Hand Meeting” in Basel

June 12, 2015, 1:59 am
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Swimming in the Rhein (photo Dr. Gohritz)
  The „Trinational Hand Meeting“ in Basel, Switzerland in May 2015 was organized by Prof. Schaefer, head of Plastic and Hand Surgery and his team at Basel University Hospital. This special meeting united only personally invited hand surgeons from the Rhein region of Germany, Switzerland and France to exchange practical experience and knowledge by discussing clinical cases in a friendly and relaxed atmosphere. The invited speaker of this year was Jan Fridén who presented an “Update on Functional Restoration in the Upper Extremity after Spinal Cord Injury and Amputation”.
The meeting took place at the Medartis Campus in Basel and also included an exciting guided tour through the high-technology production sites of modern osteosynthesis material. The scientific part was followed by a refreshing swim in the Rhein and an invitation of the host to have a superb dinner with amicable conversations at the traditional Basel restaurant “Schlüsselzunft”.
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Invited State-of-the-Art Lecture at German-Speaking Spinal Cord Society Meeting

June 27, 2015, 2:53 am
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An invited special lecture on tetraplegia hand surgery was delivered by Jan Fridén at the 28th congress of the Deutschsprachige Medizinische Gesellschaft für Paraplegie (DMGP, German-Speaking Medical Society of Paraplegia) on June 24-27, 2015. This annual meeting united physicians and therapists working at spinal cord centers of Germany, Austria and Switzerland was held in Kassel, Germany, perfectly organized by Dr. Marion Saur (photo right). Important scientific contributions were made by the Nottwil team and the special lecture was exceptionally well received by the audience. Many detailed and inspiring questions and a lively discussion reflected the growing interest of the rehabilitation medicine community on surgical rehabilitation of arm and hand function. The next DMGP meeting will be in 2016 in Hamburg, Germany - www.dmgp-kongress.de
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Review Article on Upper Extremity Nerve Transfer Published with Australian Research Partners

August 25, 2015, 3:17 am
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An important state-of-the-art paper entitled “Review of Upper Extremity Nerve Transfer in Cervical Spinal Cord Injury” was published in the open-access journal “Brachial Plexus and Peripheral Nerve Injury“. Together with first and last authors Sarah Cain and Natasha van Zyl from University of Melbourne, Australia, Andreas Gohritz and Jan Fridén summarized an analysis of  all nerve transfer cases published to date in the literature. This review summarizes the functional results in 59 cases with 89 nerve transfers performed, including 15 cases of double-nerve transfer and 1 case of triple-nerve transfer from 13 studies with extractable data. Overall, 89 nerve transfers have been performed in 57 males and 2 females with a mean age of 34 years. The mean SCI level was C6 (range: C5–7), time to surgery post-SCI was 19.9 months (range: 4.1–156 months), and follow-up time was 18.2 months (range: 3–60 months). All case reports recorded a Medical Research Council (MRC) score of 3 or 4 for recipient muscle power, but two early case series reported more variable results.
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Tetraplegia Hand Surgery Topic at Austrian Trauma Society

October 2, 2015, 1:43 am
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Old Town Salzburg
The Austrain Trauma Society (Österreichische Gesellschaft für Unfallchirurgie) congress in Salzburg, arranged a symposium on reconstruction of hand function after damage to central and peripheral nervous system. Professors Robert Schmidhammer and Jan Fridén overviewed the topics "Functional Improvement of  Upper Extremity Function after Peripheral Nerve Injuries and "Improvement of Upper Extremity Function in Tetraplegia by Surgery".  Both presenters not only detailed the surgical procedures but also emphasized the need for a solid team efforts and patient-perceived outcome measurements. Discussions dealt with several important issues in a broader perspective for example  strategies to establish routines for early assessments and how to establish solid and sustainable organizations to guarantee continous development and service.
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Tetrahand World Congress 2018

January 8, 2018, 2:14 am
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It is a great pleasure to announce the Tetrahand World Congress 2018 in Nottwil, Switzerland . This will be the 12th International Congress on Surgery and Rehabilitation of the Upper Extremity in Tetraplegia.
Our congress will be held in conjunction with the annual IFESS (International Functional Electrical Stimulation Society) Congress at the Swiss Paraplegic Centre on 28-31 August 2018.(IFESS 2018 Congress website)
We are looking forward to an outstanding scientific program covering the key topics of Tetrahand surgery and rehabilitation with focus on patient perceived outcomes, innovative techniques and workshops for surgeons and therapists.
I offer you a warm welcome to the Tetrahand World Congress 2018 and look forward to seeing you in Nottwil!

Jan Fridén
Congress Chair
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