General indications for functional surgery of the hand in tetraplegic patients.

General indications for surgery of the upper limb cannot be codified and do not follow any general rules. Each case is different, and a successful outcome depends on the experience acquired by a specialized surgeon, the team that surrounds the patient, and the customization of treatment to the personality and wishes of the patient. In addition, direct and caring human contract between the surgeon and his patient are fundamental. Today, many tetraplegic patients who are confined to their wheelchairs spend much of their time on the computer, eager to obtain as much information as possible about their condition from the Internet. One must stress, however, the risks of the false and partial information they might find. Surgical indications should be assessed only after a clinical evaluation and a long and personal discussion between the surgeon and the patient, who in this way establish a covenant between them. In the 21st century, patients will continue to become better informed, but the surgeon will maintain his role as mediator between the patient and surgery.