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. 2025 Feb 7;7(2):368-375.
doi: 10.1016/j.jhsg.2025.01.008. eCollection 2025 Mar.

Beyond Amputation: Functional Restoration after Upper-Extremity Limb Loss

Jonathan T Bricker  1 , Kazimir R Bagdady  1 , Lindsay E Janes  1 , Jason M Souza  2 , Gregory A Dumanian  1 , Jason H Ko  1
Affiliations

Beyond Amputation: Functional Restoration after Upper-Extremity Limb Loss

Jonathan T Bricker et al. J Hand Surg Glob Online. .

Abstract

Several factors have contributed to poor quality of life outcomes for upper-extremity amputees. In recent decades, the advancements in both surgical procedures and prosthetics have been aimed at both improving the function and quality of life of amputees. Targeted muscle reinnervation, regenerative peripheral nerve interfaces, agonist-antagonist myoneural interfaces, free tissue transfers, and limb transplantation are chief among the surgical options available for improved sensorimotor function in residual and prosthetic limbs. New technologies such as cuff electrodes, intraneural filaments, and various osseointegrated prosthesis systems are used either alone or in concert with these operative techniques. Procedural and technological advancements will continue to push the limits of functional restoration after upper-extremity limb loss.

Keywords: Free tissue transfer; Osseointegration; Regenerative peripheral nerve interfaces; Targeted muscle reinnervation; Upper-extremity amputation.

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Conflict of interest statement

No benefits in any form have been received or will be received related directly to this article.

Figures

Figure 1
Figure 1
Intraoperative photos of A tagged motor nerve targets for TMR and B coapted TMR after a transhumeral amputation.
Figure 2
Figure 2
Intraoperative photos of A a nonsalvageable hand requiring B transradial amputation and C acute TMR.
Figure 3
Figure 3
Intraoperative photos showing a radial sensory neuroma treated with RPNI A before and B after excision and muscle wrapping.
Figure 4
Figure 4
Radiographic image of the e-OPRA system after implantation.
Figure 5
Figure 5
Photos of the e-OPRA system A intraoperatively with associated intramuscular and intraneural electrodes allowing for bidirectional sensorimotor integration between the prosthesis and the patient and B,C after surgery.
Figure 6
Figure 6
Free fillet flap used in a forequarter amputation showing A the amputated upper extremity, B precoaptation, C flap inset, and D postoperative result.
Figure 7
Figure 7
Intraoperative photos of a transradial amputation residual limb length preservation surgery using a free ALT flap showing A the pre-flap residual upper extremity; B,C the ALT free flap after harvest; D the prepared residual upper limb; E TMR; and F final flap inset.
See this image and copyright information in PMC

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