Selected
spastic patients with
cerebral palsy can be helped by peripheral reconstructive surgery, of the upper limb. Although surgery cannot make a limb that was functionally poor into a perfect one, it can greatly improve the preoperative condition. Most poor surgical results are caused by incorrect selection of patients or poor execution of
surgical procedures. The worst mistake is to
perform soft tissue procedures--tendinous release or tendinous transfers--on a patient with pure
athetosis. The results in these cases are unpredictable and often fail. The same concept is applied to rigidity,
hypotonia,
dystonia, and
ataxia. The surgical program is organized according to the type and severity of the
deformity (clinical groups). The goals are to correct the
deformities and to improve the muscular balance of the hand in one surgical stage. It must be remembered that
spastic muscle cannot be used for
tendon transfer with the same efficiency as in patients with a flaccid
paralysis. Results were satisfactory in 92% of cases of groups I and II. If group III is included, the percentage of satisfactory results reduces significantly.