Nerve Transfers

At Tetrahand Cyprus, we perform highly specialized nerve transfer procedures to restore movement and sensation in the upper limbs following spinal cord injuries, brachial plexus injuries, or other nerve-related conditions. These microsurgical techniques redirect healthy, functioning nerves to reanimate paralyzed muscles—helping patients recover lost abilities.

Reconstruction of Functional Grip with the ALPHABET Procedure

The ability to grasp, hold, and release objects is a fundamental aspect of human function. For individuals with tetraplegia or severe upper limb impairments due to spinal cord injury, regaining this ability can significantly improve independence and quality of life. The ALPHABET Procedure is an advanced surgical approach developed to restore functional grip and hand use in patients with impaired motor control. At Tetrahand Cyprus, we specialize in performing this transformative procedure as part of our commitment to improving upper limb function in complex cases.

Understanding Functional Grip and Its Importance

Functional grip refers to the coordinated ability of the hand to perform grasping actions such as power grip, precision pinch, and key pinch. These movements are essential for everyday activities—from feeding and hygiene to using a phone or writing. When the nerves and muscles that control these movements are compromised due to spinal cord injury or neurological damage, individuals often experience a complete or partial loss of hand function.

The ALPHABET Procedure addresses this loss through a structured and personalized surgical technique that reconstructs critical grip functions.

What is the ALPHABET Procedure?

The ALPHABET Procedure is a comprehensive reconstructive surgery that combines multiple tendon and nerve transfers to restore grip, pinch, and release abilities in patients with tetraplegia or upper limb paralysis. Named to reflect its systematic, step-by-step approach, the ALPHABET Procedure creates a “language” of hand movements by prioritizing the reconstruction of the most functionally important grips—such as:

• A: Active key pinch

• L: Lateral grasp

• P: Palmar grip

• H: Hook grip

• A: Active finger extension

• B: Balanced wrist stabilization

• E: Efficient tendon tensioning

• T: Thumb positioning and control

Each element of the procedure focuses on restoring one key aspect of hand use. Depending on the patient's residual muscle activity and level of injury, specific techniques are selected and tailored to provide the most natural and powerful outcome.

How the Procedure Works

The ALPHABET Procedure often includes:

• Tendon Transfers: Functioning muscles (e.g., from the forearm) are repurposed to replicate the action of paralyzed hand muscles. For instance, a working wrist extensor may be reattached to mimic finger flexion.

• Nerve Transfers: Donor nerves with preserved function are rerouted to restore voluntary control to key muscles in the hand and forearm.

• Joint Balancing and Stabilization: Tendons and ligaments may be adjusted to ensure proper alignment and mechanical advantage, enhancing precision and strength.

• Thumb Reconstruction: The thumb is a cornerstone of grip. The ALPHABET Procedure includes careful restoration of thumb opposition and stabilization, often through FPL (flexor pollicis longus) or EPL (extensor pollicis longus) tendon transfers.

The surgery is typically performed in a single session, minimizing the need for repeated hospital visits and reducing overall recovery time.

Who is a Candidate?

Ideal candidates for the ALPHABET Procedure are individuals with:

• Tetraplegia from cervical spinal cord injury (usually C5–C7 level)

• Residual active muscle control in parts of the upper limb (e.g., elbow or wrist extension)

• Stable medical condition with no active infection or progressive disease

• High motivation and commitment to post-surgical rehabilitation

A thorough pre-operative assessment is essential. At Tetrahand Cyprus, we use clinical exams, electromyography, and functional evaluations to design a personalized surgical roadmap for each patient.

Rehabilitation After Surgery

Rehabilitation is a key component of success. After the ALPHABET Procedure, patients begin a structured rehabilitation program involving:

• Early mobilization and passive range of motion exercises

• Progressive muscle re-education and strengthening

• Task-based functional training (e.g., gripping utensils, typing, self-care)

The goal is not just to restore movement, but to translate movement into function. Many patients report significant gains in their ability to independently eat, dress, use electronic devices, and perform basic self-care within a few months of surgery.

Results and Outcomes

The ALPHABET Procedure has shown remarkable functional improvements in eligible patients:

• Over 80% regain purposeful grip and/or pinch

• Significant reductions in caregiver dependency

• Enhanced quality of life, confidence, and autonomy

These results depend heavily on timely surgical intervention, appropriate selection, and a strong rehabilitation program—all pillars of care at Tetrahand Cyprus.

Why Choose Tetrahand Cyprus?

Our center, co-founded by Professor Jan Fridén and Dr. Constantinos Kritiotis, brings international expertise in upper limb reconstruction to Cyprus. We are one of the few specialized teams performing the ALPHABET Procedure in Europe, offering patients a chance to restore function where conventional treatments have reached their limits.

With a multidisciplinary approach, advanced surgical planning, and compassionate care, Tetrahand Cyprus continues to transform lives—one functional hand at a time.