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. 2019 Dec;131(23-24):599-607.
doi: 10.1007/s00508-019-1518-1. Epub 2019 Jun 14.

Bionic reconstruction : Restoration of extremity function with osseointegrated and mind-controlled prostheses

Martin Aman  1   2 , Christopher Festin  1 , Matthias E Sporer  1   2 , Clemens Gstoettner  1 , Cosima Prahm  1 , Konstantin D Bergmeister  2   3 , Oskar C Aszmann  4   5   6
Affiliations

Bionic reconstruction : Restoration of extremity function with osseointegrated and mind-controlled prostheses

Martin Aman et al. Wien Klin Wochenschr. 2019 Dec.

Abstract

Background: Loss of an extremity at any level has a major impact on a patient's life. Using bionic reconstruction, extremity function can be restored and the patient reintegrated into daily life. Surgical procedures including selective nerve transfer and anchoring of prostheses into bone are combined with structured rehabilitation and modern prosthetic fitting. The patient is thereby able to use the prostheses intuitively and with multiple degrees of freedom.

Methods: This article presents the concept and approach for modern bionic reconstruction in detail and the relevant literature. The nerve transfer matrices for targeted muscle reinnervation (TMR) and the concept of osseointegration to optimally fit a patient with a modern prosthesis are described in detail. As a clinical example, the case of a patient who suffered from traumatic amputation and subsequently received TMR in combination with an osseointegrated implant and structured rehabilitation is presented.

Results: Using bionic reconstruction, basic hand functions can be restored and bimanual dexterity can expand the range of daily activities. Besides this approach to bionic reconstruction, its advantages and disadvantages are compared to hand transplantation. The limitations and perspectives of modern bionic reconstruction are also discussed.

Conclusions: Bionic reconstruction is a sophisticated method for restoring extremity function and nowadays can be considered a standard of care for all levels of upper extremity amputations. An interdisciplinary approach and structured rehabilitation are necessary to master prosthetic function to ultimately reintegrate patients into daily life.

Keywords: Bionic reconstruction; Interface; Osseointegration; Prostheses; Rehabilitation.

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Conflict of interest statement

M. Aman, C. Festin, M.E. Sporer, C. Gstoettner, C. Prahm, K.D. Bergmeister, and O.C. Aszmann declare that they have no competing interests. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.

Figures

Fig. 1
Fig. 1
Intraoperative situs of targeted muscle reinnervation. Marked are the musculocutaneus nerve and its branches to the long and short head of the biceps and brachial muscle as well as the N. cutaneus antebrachii lateralis
Fig. 2
Fig. 2
Bone preparation for implant insertion by manually drilling longitudinally into the remaining part of the humerus
Fig. 3
Fig. 3
Postoperative control X‑ray of the osseointegrated implant in the humerus
Fig. 4
Fig. 4
Amputation stump with the osseointegrated implant to connect the prosthesis directly to the skeleton
Fig. 5
Fig. 5
Surface EMG signal training with visualization of the signals for optimal rehabilitation
Fig. 6
Fig. 6
After bionic reconstruction, the patient gains independence in daily life activities. Due to osseointegration, an impressive range of motion is accomplished in the shoulder joint. With a standard prosthesis with traditional shafts, this range of motion cannot be achieved
See this image and copyright information in PMC

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