title: Upper extremity limb loss: functional restoration from prosthesis and targeted reinnervation to transplantation.
abstract: For several decades, prosthetic use was the only option to restore function after upper extremity amputation. Recent years have seen advances in the field of prosthetics. Such advances include prosthetic design and function, activity-specific devices, improved aesthetics, and adjunctive surgical procedures to improve both form and function. Targeted reinnervation is one exciting advance that allows for more facile and more intuitive function with prosthetics following proximal amputation. Another remarkable advance that holds great promise in nearly all fields of medicine is the transplantation of composite tissue, such as hand and face transplantation. Hand transplantation holds promise as the ultimate restorative procedure that can provide form, function, and sensation. However, this procedure still comes with a substantial cost in terms of the rehabilitation and toxic immunosuppression and should be limited to carefully selected patients who have failed prosthetic reconstruction. Hand transplantation and prosthetic reconstruction should not be viewed as competing options. Rather, they are two treatment options with different risk/benefit profiles and different indications and, hence vastly different implications.
authors.affiliation: Mayo Clinic, Division of Hand Surgery, Rochester, MN, USA; Mayo Clinic, Division of Plastic Surgery, Rochester, MN, USA. Electronic address: carlsen.brian@mayo.edu.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Carlsen
authors.affiliation: Advanced Arm Dynamics, North Central Center of Excellence, Maple Grove, MN, USA.
authors.forename: Pat
authors.initials: P
authors.lastname: Prigge
authors.affiliation: Advanced Arm Dynamics, North Central Center of Excellence, Maple Grove, MN, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Peterson
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000534:rehabilitation* / Q000601:surgery*; D001134:Arm Injuries / Q000175:diagnosis / Q000601:surgery*; D001186:Artificial Limbs; D005260:Female; D005544:Forecasting; D063987:Hand Transplantation / Q000379:methods / Q000639:trends*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009416:Nerve Regeneration / Q000502:physiology; D011474:Prosthesis Design; D017755:Prosthesis Fitting / Q000379:methods / Q000639:trends; D011788:Quality of Life; D011877:Radionuclide Imaging; D020127:Recovery of Function; D018570:Risk Assessment; D012684:Sensory Thresholds / Q000502:physiology; D016896:Treatment Outcome; D034941:Upper Extremity / Q000000981:diagnostic imaging
keywords: Amputation; Hand transplantation; Limb loss; Prosthetics