Staged opposition transfer.

Six patients sustained extensive hand and upper limb trauma, including median nerve and/or thenar muscle loss. Initial treatment consisted of various median nerve and/or soft tissue reconstructions. Because of extensive palmar scarring and lack of useful opposition (Kapandji stage 3), a 2-stage opposition transfer was performed. In stage 1, a silicone rod was placed along the path of the intended tendon transfer. In stage 2, the rod was removed and the donor tendon was passed through the pseudosheath to the point of insertion at the thumb. All patients were monitored for a minimum of 1 year and all achieved significant functional improvement, documented by Kapandji stage 6 opposition in 1 patient and by at least stage 7 or 8 opposition in the other 5 patients.