Bionic reconstruction after severe limb trauma and limb loss

Abstract

Severe brachial plexopathies, massive soft tissue damage of the forearm, electrocution injuries, acute compartment syndrome with consequent Volkmann’s Contracture and many other mutilations of the arm and hand may lead to a more or less functionless hand. These defects pose a major reconstructive challenge and currently there are only a few therapeutic options with very moderate outcome Depending on the cause of injury either the neurological deficit, the actual loss of functional tissues or the poor trophic state of the hand do not allow meaningful biological reconstruction. We have now developed different strategies that combine complex prosthetic systems with sophisticated surgical techniques to create novel neurological landscapes so that patients can interact with complex mechatronic devices in an intuitive and natural way. For this purpose we selectively transfer nerves that have lost their targets to free functional muscles transplants in the forearm to provide a new neurological surface to express lost hand function. These muscles then act as bioamplifiers of peripheral nerve signals that can power specific movements of a prosthetic device with several degrees of freedom. Here we present our experience with this new concept of “bionic reconstruction” in various scenarios of challenging upper extremity defects.