title: Elective amputation and bionic substitution restore functional hand use after critical soft tissue injuries.
abstract: Critical soft tissue injuries may lead to a non-functional and insensate limb. In these cases standard reconstructive techniques will not suffice to provide a useful outcome, and solutions outside the biological arena must be considered and offered to these patients. We propose a concept which, after all reconstructive options have been exhausted, involves an elective amputation along with a bionic substitution, implementing an actuated prosthetic hand via a structured tech-neuro-rehabilitation program. Here, three patients are presented in whom this concept has been successfully applied after mutilating hand injuries. Clinical tests conducted before, during and after the procedure, evaluating both functional and psychometric parameters, document the benefits of this approach. Additionally, in one of the patients, we show the possibility of implementing a highly functional and natural control of an advanced prosthesis providing both proportional and simultaneous movements of the wrist and hand for completing tasks of daily living with substantially less compensatory movements compared to the traditional systems. It is concluded that the proposed procedure is a viable solution for re-gaining highly functional hand use following critical soft tissue injuries when existing surgical measures fail. Our results are clinically applicable and can be extended to institutions with similar resources.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.|Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
authors.forename: Oskar C
authors.initials: OC
authors.lastname: Aszmann
authors.affiliation: Institute of Neurorehabilitation Systems, Bernstein Focus Neurotechnology Göttingen, University Medical Center Göttingen, Georg-August University, Von-Siebold-Str. 6, 37075 Göttingen, Germany.
authors.forename: Ivan
authors.initials: I
authors.lastname: Vujaklija
authors.affiliation: Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
authors.forename: Aidan D
authors.initials: AD
authors.lastname: Roche
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.|Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Salminger
authors.affiliation: Department of Physical and Rehabilitation Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
authors.forename: Malvina
authors.initials: M
authors.lastname: Herceg
authors.affiliation: Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.|Master Degree Program "Health Assisting Engineering", University of Applied Sciences FH Campus Wien, Favoritenstraße 226, 1100 Vienna, Austria.
authors.forename: Agnes
authors.initials: A
authors.lastname: Sturma
authors.affiliation: Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Hruby
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
authors.forename: Anna
authors.initials: A
authors.lastname: Pittermann
authors.affiliation: Otto Bock Healthcare Products GmbH, Brehmstraße 16, 1110 Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Hofer
authors.affiliation: Otto Bock Healthcare Products GmbH, Brehmstraße 16, 1110 Vienna, Austria.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Amsuess
authors.affiliation: Institute of Neurorehabilitation Systems, Bernstein Focus Neurotechnology Göttingen, University Medical Center Göttingen, Georg-August University, Von-Siebold-Str. 6, 37075 Göttingen, Germany.
authors.forename: Dario
authors.initials: D
authors.lastname: Farina
mesh_terms: D000671:Amputation, Surgical; D001186:Artificial Limbs; D001701:Bionics / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods*; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D017695:Soft Tissue Injuries / Q000601:surgery*; D016896:Treatment Outcome