Tetrahand Cyprus was created from a collaboration between Professor Jan Friden and Dr Constantinos Kritiotis in 2015. The aim of this pioneer service was to provide care and upper limb reconstruction surgery to patients with tetraplegia following spinal cord injury, to patients with spasticity after brain or spinal cord injury trauma (like cerebral palsy, strokes etc) as well as patients with brachial plexus and peripheral nerve injuries
Tetrahand Cyprus was created from a collaboration between Professor Jan Friden and Dr Constantinos Kritiotis in 2015. The aim of this pioneer service was to provide care and upper limb reconstruction surgery to patients with tetraplegia following spinal cord injury, to patients with spasticity after brain or spinal cord injury trauma (like cerebral palsy, strokes etc) as well as patients with brachial plexus and peripheral nerve injuries
Our Procedures
Reconstruction of Elbow Extension with Posterior Deltoid to Triceps Transfer
This surgical method restores elbow extension in tetraplegic patients by transferring the posterior deltoid muscle’s tendon to the triceps tendon. Pioneered by experts like Professor Jan Fridén, it leverages the deltoid’s strength to compensate for triceps paralysis, often due to spinal cord injury. Performed in a single-stage operation, the procedure minimizes recovery time. Post-surgery, patients begin active rehabilitation within days, promoting muscle activation and preventing adhesions. This enhances independence by enabling overhead reach and wheelchair propulsion. Reliable tendon attachments ensure lasting results, with studies showing significant functional gains and patient satisfaction over time.
Reconstruction of Functional Grip with the ALPHABET Procedure
The ALPHABET procedure rebuilds functional grip in tetraplegia through a structured mix of tendon transfers and tenodesis. It targets essential hand movements like grasping and pinching for daily activities. By redirecting active muscles, such as the brachioradialis, to flexor tendons, it restores grip strength. Conducted in a single surgery, it streamlines recovery. Early post-operative mobilization helps patients adapt quickly, improving outcomes. Tailored to individual deficits, this approach enhances hand function and autonomy. It’s a practical solution for those with paralyzed hands, offering reliable results and better quality of life.
Spasticity Reduction Procedures Using Hyperselective Neurectomies, Tenotomies, and Tendon Lengthenings
Spasticity reduction in tetraplegia uses hyperselective neurectomies, tenotomies, and tendon lengthenings to manage muscle overactivity. Hyperselective neurectomy cuts specific nerve branches to reduce spasticity while preserving power. Tenotomies release tight tendons, and lengthenings adjust muscle tension to prevent contractures. Often combined, these techniques improve limb positioning, reduce pain, and aid movement. They require precision but involve minimal recovery time, integrating well with rehabilitation. The result is better comfort and control for patients, addressing a common challenge in tetraplegia. These procedures enhance overall upper extremity function effectively.
Tendon Transfers to Balance the Hand and Restore Functions
Tendon transfers rebalance the tetraplegic hand by rerouting working muscles to replace paralyzed ones, restoring grip and pinch functions. Using available motors like the brachioradialis or extensor carpi radialis, it powers flexor or extensor tendons. Done in one surgery, it boosts efficiency and cuts recovery time. Early rehabilitation strengthens the transfers, avoiding stiffness and improving results. Customized to each patient’s needs, this method enhances dexterity and independence. It’s a proven approach to improve hand function, enabling everyday tasks and significantly elevating patients’ quality of life.
Nerve Transfers in Suitable Patients
Nerve transfers reinnervate paralyzed muscles in tetraplegia by redirecting intact nerves, restoring natural movement. Best for early intervention (within 18 months post-injury), it targets elbow extension, grasp, and hand opening. Unlike tendon transfers, it maintains muscle biomechanics, though reinnervation is slower. Sometimes paired with tendon techniques, it maximizes recovery. Research shows over 80% of patients gain significant strength, making it ideal for younger individuals seeking long-term gains. This advanced method offers a promising way to improve upper limb function, enhancing independence for suitable candidates with spinal cord injuries.
Constantinos Kritiotis
Constantinos Kritiotis
Dr. Constantinos Kritiotis is a distinguished medical professional specializing in orthopaedic and hand surgery. A graduate of the esteemed University of Athens Medical School, Dr. Kritiotis began his journey into the world of medicine with a strong academic foundation and a passion for improving patients’ quality of life through surgical excellence.
In 2020, Dr. Kritiotis returned to his home country of Cyprus, bringing with him over a decade of international surgical experience. He is currently based at Iasis Hospital in Paphos, where he focuses exclusively on hand surgery, offering both surgical and non-surgical treatment options tailored to each patient’s unique needs. His services are provided within the framework of the General Healthcare System (GHS/GESY), ensuring accessible and standardized care for all eligible patients.
He is known for his meticulous surgical technique, compassionate approach, and commitment to staying abreast of the latest advancements in his field. His ongoing mission is to restore function, reduce pain, and help his patients return to their daily lives with confidence and comfort.
Jan Fridén
Jan Fridén
In addition to his clinical and surgical achievements, Professor Fridén is an esteemed educator and mentor, actively involved in training the next generation of reconstructive surgeons. He holds appointments at several prestigious academic and medical institutions, where he combines surgical excellence with a strong commitment to teaching and research.
At the heart of Professor Fridén’s work lies a deep-seated commitment to enhancing patient mobility and independence. Through his continued innovation, international collaboration, and patient-first philosophy, he has set new standards in the field of upper limb surgery and continues to inspire colleagues and patients alike.
About us
This specialized service was co-founded by Professor Jan Fridén, a globally recognized expert in upper limb reconstruction for tetraplegia, and Dr. Constantinos Kritiotis, a leading hand surgeon based in Cyprus with extensive international experience. United by a shared vision to improve lives through function-restoring surgery, they created a unique service offering advanced upper limb reconstruction to patients with complex neurological and nerve-related conditions. Professor Fridén has spent decades developing and refining surgical techniques that restore motor function in individuals with tetraplegia following spinal cord injury. His work has revolutionized reconstructive surgery and influenced care worldwide. Dr. Kritiotis, following years as a Consultant Hand Surgeon in the UK and now based at Iasis Hospital in Paphos, brings a wealth of practical expertise and personalized care to patients across Cyprus.Together, they provide surgical solutions for:
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Tetraplegic patients seeking improved hand and arm function
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Individuals with spasticity caused by cerebral palsy, stroke, or brain/spinal injuries
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Patients with brachial plexus or peripheral nerve damage
Strategically located in Paphos, Cyprus, within a four hour direct flight from mainland Europe and the Middle East, Tetrahand Cyprus offers world class care from respective leaders in their field. Our values are based on innovation, companion, multidisciplinary collaboration but above all, passion for what we do!
Driven by clinical excellence and a passion for improving outcomes, this service stands at the forefront of upper limb reconstruction, bringing new possibilities to those once considered untreatable.
Constantinos Kritiotis
Constantinos Kritiotis
Jan Fridén
Jan Fridén
About us
Dr. Constantinos Kritiotis and Professor Jan Fridén are renowned hand surgery experts whose collaboration birthed Tetrahand Cyprus in 2015. Dr. Kritiotis, a University of Athens graduate, trained in Orthopaedics in Cyprus (2007-2012) and honed his skills in the UK after a 2013 Birmingham fellowship, before returning to Iasis Hospital in Paphos in 2020 under GHS (GESY).
Instructional Videos Of Our Procedures
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