The surgical reconstruction of the upper extremity paralyzed by poliomyelitis.

In this category we are confronted with several problems of treatment to which consideration must be given, the over-all gain sought for the patient being of primary importance. The function remaining to the individual will determine the plan for the projected goal. Some patients can be expected to gain only in self-care activities; others with less general involvement may perform heavy labor following a surgical procedure. Isolated paralysis amenable to surgical treatment is not the rule, although it certainly does occur. A wide middle ground of improvement is the usual goal. It must be clear that the gain from the proposed procedure will not be offset by an important loss, that muscles or functions important to the patient will not be sacrificed without compensatory benefit. Before an adequate plan for any patient can be devised, the surgeon should be cognizant of those motions which need to be replaced and of their relative functional importance. It is our present habit to think in terms of motion to be regained rather than of the muscles paralyzed by disease. Those motions important in upper-extremity function are grasp or some part thereof, wrist motion or stability, pronatiomi and supination, elbow flexion and extension or stabihity, humeral imitemnal arid external rotation, and humeral forward flexion. Scapulo-