Hand reanimation.

Brachial plexus disruption, major traumatic amputations, and Volkmann's contracture are all devastating injuries that present difficult reconstructive challenges. Advances in our understanding of nerve injury, regeneration, and refinement of microsurgical techniques have given rise to a number of therapeutic avenues over the last 4 decades. Hand reanimation aims to provide strength, stability, and mobility to a sensate hand. How this is achieved depends on a thorough understanding of the underlying pathophysiology, which in turn dictates what surgical modalities are suitable. Common to all reanimation procedures is the need to ensure full passive range of motion of the target joints prior to definitive surgery. Hand therapy is essential to prevent deleterious sequelae of injury, and to maximize rehabilitation following surgical reconstruction. Options for reanimation include nerve repair, nerve grafting, nerve transfer, tendon transfer, and free functioning muscle transfer.