40 years of experience in functional surgery of the tetraplegic upper limb.

The author relates his 40 years of experience in the field of functional surgery of the tetraplegic upper limb (FSTUL). After having introduced and developed this specialty in France, he disseminated it to various countries where he saw a large number of patients and acquired extensive experience. He presents his personal progression and discusses the recent therapies in this field. FSTUL is a personalize surgery, with each case being unique. It must, first and foremost, take into consideration the real wishes of a motivated and well-informed patient and consider the type of spinal cord injury (not only the upper level of the lesional segment but also the extent of the sub-lesional segment). The surgical indication and rehabilitation are very important factors in the outcome. The main goal of FSTUL is rapid social reintegration of the patient; in some cases, this could involve fewer surgical procedures and shorter stays in rehabilitation centers. FSTUL is in constant evolution and can be improved; it is a useful but not well-known surgery.