Bionic reconstruction to restore hand function after brachial plexus injury: a case series of three patients.
BACKGROUND
Brachial plexus injuries can permanently impair hand function, yet present surgical reconstruction provides only poor results. Here, we present for the first time bionic reconstruction; a combined technique of selective nerve and muscle transfers, elective amputation, and prosthetic rehabilitation to regain hand function.


METHODS
Between April 2011, and May 2014, three patients with global brachial plexus injury including lower root avulsions underwent bionic reconstruction. Treatment occurred in two stages; first, to identify and create useful electromyographic signals for prosthetic control, and second, to amputate the hand and replace it with a mechatronic prosthesis. Before amputation, the patients had a specifically tailored rehabilitation programme to enhance electromyographic signals and cognitive control of the prosthesis. Final prosthetic fitting was applied as early as 6 weeks after amputation.


RESULTS
Bionic reconstruction successfully enabled prosthetic hand use in all three patients. After 3 months, mean Action Research Arm Test score increased from 5·3 (SD 4·73) to 30·7 (14·0). Mean Southampton Hand Assessment Procedure score improved from 9·3 (SD 1·5) to 65·3 (SD 19·4). Mean Disabilities of Arm, Shoulder and Hand score improved from 46·5 (SD 18·7) to 11·7 (SD 8·42).


CONCLUSIONS
For patients with global brachial plexus injury with lower root avulsions, who have no alternative treatment, bionic reconstruction offers a means to restore hand function.


BACKGROUND
Austrian Council for Research and Technology Development, Austrian Federal Ministry of Science, Research & Economy, and European Research Council Advanced Grant DEMOVE.
Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Austria. Electronic address: oskar.aszmann@meduniwien.ac.at.
Oskar C
OC
Aszmann
Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Austria.
Aidan D
AD
Roche
Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Austria.
Stefan
S
Salminger
Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Austria.
Tatjana
T
Paternostro-Sluga
Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Austria.
Malvina
M
Herceg
Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Austria.
Agnes
A
Sturma
Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Austria; Clinical Research, Research & Development, Otto Bock Healthcare Products GmbH, Vienna, Austria.
Christian
C
Hofer
Department of Neurorehabilitation Engineering, Bernstein Focus Neurotechnology Göttingen, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.
Dario
D
Farina
D000328:Adult; D000671:Amputation, Surgical; D001186:Artificial Limbs; D001701:Bionics / Q000379:methods*; D001917:Brachial Plexus / Q000293:injuries*; D020516:Brachial Plexus Neuropathies / Q000534:rehabilitation*; D004576:Electromyography; D006225:Hand / Q000502:physiology; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function / Q000502:physiology*; D016896:Treatment Outcome