Surgical and technological advances in the management of upper limb amputees

2021 ◽  
Vol 103-B (3) ◽  
pp. 430-439
Author(s):  
Michael Geary ◽  
Raymond Glenn Gaston ◽  
Bryan Loeffler
Keyword(s):  
Peripheral Nerve ◽  
Upper Limb ◽  
Technological Development ◽  
Surgical Techniques ◽  
Paradigm Shifts ◽  
Myoelectric Signal ◽  
Targeted Muscle Reinnervation ◽  
Technological Advances ◽  
Peripheral Nerve Interface ◽  
Near Future

Upper limb amputations, ranging from transhumeral to partial hand, can be devastating for patients, their families, and society. Modern paradigm shifts have focused on reconstructive options after upper extremity limb loss, rather than considering the amputation an ablative procedure. Surgical advancements such as targeted muscle reinnervation and regenerative peripheral nerve interface, in combination with technological development of modern prosthetics, have expanded options for patients after amputation. In the near future, advances such as osseointegration, implantable myoelectric sensors, and implantable nerve cuffs may become more widely used and may expand the options for prosthetic integration, myoelectric signal detection, and restoration of sensation. This review summarizes the current advancements in surgical techniques and prosthetics for upper limb amputees. Cite this article: Bone Joint J 2021;103-B(3):430–439.

scholarly journals Der chirurgische Umgang mit peripheren Nerven nach Extremitätenverlust

2020 ◽  
Author(s):  
Clemens Gstoettner ◽  
Gregor Laengle ◽  
Stefan Salminger ◽  
Christopher Festin ◽  
Hannes Platzgummer ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Targeted Muscle Reinnervation ◽  
Muscle Reinnervation ◽  
Peripheral Nerve Interface

Zusammenfassung Hintergrund Nach Verlust einer Gliedmaße ist es die Aufgabe des Chirurgen, einen möglichst schmerzfreien und belastbaren Stumpf zu formen. Hierbei kommt insbesondere an der oberen Extremität ein funktioneller Aspekt hinzu, da zur Steuerung myoelektrischer Prothesen entsprechende Muskelsignale notwendig sind. Der Umgang mit peripheren Nerven im Stumpfbereich nimmt sowohl hinsichtlich der Schmerztherapie als auch der funktionellen Mensch-Maschinen-Anbindung eine zentrale Rolle ein. Ziel der Arbeit Die Darstellung aktueller chirurgischer Verfahren zum Umgang mit peripheren Nerven nach Extremitätenamputation. Material und Methoden Es erfolgt eine Literaturrecherche bzgl. chirurgischer Prophylaxe und Therapie von Neurom- und Phantomschmerzen, sowie zu Techniken zur Verbesserung der funktionellen Schnittstelle zwischen Stumpf und Prothese. Anhand relevanter Arbeiten sowie der Erfahrungen der Autoren werden entsprechende Empfehlungen formuliert. Ergebnisse und Diskussion Es gibt eine große Anzahl an verschiedenen Operationstechniken, insbesondere im Umgang mit schmerzhaften Neuromen. Von den klassischen Verfahren findet besonders häufig die intramuskuläre Verlagerung der endständiger Nerven Anwendung. Neuere Techniken wie Targeted Muscle Reinnervation (TMR) und Regenerative Peripheral Nerve Interface (RPNI) zielen erstmals darauf ab, dem Nerven auch nach Amputation funktionelle Endorgane zu liefern. Neben der verbesserten Steuerung myoelektrischer Prothesen zeigen diese Verfahren auch exzellente Ergebnisse in Bezug auf Neurom- und Phantomschmerzen.

scholarly journals Targeted Muscle Reinnervation Combined with a Vascularized Pedicled Regenerative Peripheral Nerve Interface

2020 ◽  
Vol 8 (3) ◽  
pp. e2689 ◽  
Author(s):  
Ian Valerio ◽  
Steven A. Schulz ◽  
Julie West ◽  
Ritsaart F. Westenberg ◽  
Kyle R. Eberlin
Keyword(s):  
Peripheral Nerve ◽  
Targeted Muscle Reinnervation ◽  
Muscle Reinnervation ◽  
Peripheral Nerve Interface

scholarly journals Peripheral Nerve Tumors as an Ongoing Challenge in Neuro-oncology: An Overview of Their Biological and Technical Nuances

2021 ◽  
Vol 49 (1, 2, 3) ◽  
pp. 54
Author(s):  
Siniša Matić ◽  
Milan Lepić ◽  
Vojin Kovačević ◽  
Jovan Grujić ◽  
Filip Vitošević ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Molecular Mechanisms ◽  
Biological Therapy ◽  
Clinical Presentation ◽  
Surgical Techniques ◽  
Intraoperative Ultrasound ◽  
High Quality ◽  
Nerve Tumor ◽  
Technological Advances ◽  
Intraoperative Electrophysiological Monitoring

<p>This paper aims to provide an overview of recent advances in the diagnosis and treatment of peripheral nerve tumors (PNTs) with regard to biological and technological nuances, and to highlight some recommendations for achieving better outcomes in the treatment of patients suffering from PNT. PNTs are probably the most challenging entity in the field of peripheral nervous system surgery. The goal of removing a nerve tumor while also preserving nerve function at the same time is often complicated, regardless of the surgeon’s experience. Still, in most cases, high-quality results can be achieved upon carefully planned surgery. Clinical presentation, diagnosis, and indications for a specific type of treatment of PNTs still remain a topic of debate. Recent technological advances have led to an exponential improvement in the field with utilization of intraoperative ultrasound, neurostimulation devices, and intraoperative electrophysiological monitoring, along with the development of modern surgical techniques, whereby a multidisciplinary and individually shaped approach is necessary.</p><p><strong>Conclusion. </strong>These advances, however, still remain limited, and recent research is focused on the development of biological therapy. Biologically targeted therapies will emerge when there is a better understanding of the genetic and molecular mechanisms driving the development and growth of PNTs.</p>

scholarly journals A regenerative peripheral nerve interface allows real-time control of an artificial hand in upper limb amputees

2020 ◽  
Vol 12 (533) ◽  
pp. eaay2857 ◽  
Author(s):  
Philip P. Vu ◽  
Alex K. Vaskov ◽  
Zachary T. Irwin ◽  
Phillip T. Henning ◽  
Daniel R. Lueders ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Real Time ◽  
Upper Limb ◽  
Signal Amplitude ◽  
Real Time Control ◽  
Large Signal ◽  
Time Control ◽  
Peripheral Nerve Interface ◽  
Artificial Hand ◽  
Promising Source

Peripheral nerves provide a promising source of motor control signals for neuroprosthetic devices. Unfortunately, the clinical utility of current peripheral nerve interfaces is limited by signal amplitude and stability. Here, we showed that the regenerative peripheral nerve interface (RPNI) serves as a biologically stable bioamplifier of efferent motor action potentials with long-term stability in upper limb amputees. Ultrasound assessments of RPNIs revealed prominent contractions during phantom finger flexion, confirming functional reinnervation of the RPNIs in two patients. The RPNIs in two additional patients produced electromyography signals with large signal-to-noise ratios. Using these RPNI signals, subjects successfully controlled a hand prosthesis in real-time up to 300 days without control algorithm recalibration. RPNIs show potential in enhancing prosthesis control for people with upper limb loss.

Reconstruction of the Mandibular Condyle

2021 ◽  
Author(s):  
Spencer R. Anderson ◽  
Kaitlynne Y. Pak ◽  
Aurora G. Vincent ◽  
Adrian Ong ◽  
Yadranko Ducic
Keyword(s):  
Gold Standard ◽  
Traumatic Injury ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Mandibular Condyle ◽  
Facial Aesthetics ◽  
Mandibular Growth ◽  
Alloplastic Materials ◽  
Technological Advances ◽  
Integral Structure

AbstractThe mandibular condyle is an integral structure in the temporomandibular joint (TMJ) serving not only as the hinge point for mandibular opening, but also facilitating mandibular growth and contributing to facial aesthetics. Significant compromise of the TMJ can be debilitating functionally, psychologically, and aesthetically. Reconstruction of the mandibular condyle is rarely straightforward. Multiple considerations must be accounted for when preparing for condylar reconstruction such as ensuring eradication of all chronically diseased or infected bone, proving clear oncologic margins following tumor resection, or achieving stability of the surrounding architecture in the setting of a traumatic injury. Today, there is not one single gold-standard reconstructive method or material; ongoing investigation and innovation continue to improve and transform condylar reconstruction. Herein, we review methods of condylar reconstruction focusing on autologous and alloplastic materials, surgical techniques, and recent technological advances.

scholarly journals Blockchain Applications in Agribusiness: A Systematic Review

2021 ◽  
Vol 13 (4) ◽  
pp. 95
Author(s):  
Geneci da Silva Ribeiro Rocha ◽  
Letícia de Oliveira ◽  
Edson Talamini
Keyword(s):  
Complex System ◽  
Systematic Review ◽  
Web Of Science ◽  
Scientific Literature ◽  
Early Stage ◽  
Technological Development ◽  
Economic Sectors ◽  
Future Studies ◽  
Blockchain Technology ◽  
Near Future

Blockchain is a technology that can be applied in different sectors to solve various problems. As a complex system, agribusiness presents many possibilities to take advantage of blockchain technology. The main goal of this paper is to identify the purposes for which blockchain has been applied in the agribusiness sector, for which a PRISMA-based systematic review was carried out. The scientific literature corpus was accessed and selected from Elsevier’s Scopus and ISI of Knowledge’s Web of Science (WoS) platforms, using the PRISMA protocol procedures. Seventy-one articles were selected for analysis. Blockchain application in agribusiness is a novel topic, with the first publication dating from 2016. The technological development prevails more than blockchain applications since it has been addressed mainly in the Computer Sciences and Engineering. Blockchain applications for agribusiness management of financial, energy, logistical, environmental, agricultural, livestock, and industrial purposes have been reported in the literature. The findings suggest that blockchain brings many benefits when used in agribusiness supply chains. We concluded that the research on blockchain applications in agribusiness is only at an early stage, as many prototypes are being developed and tested in the laboratory. In the near future, blockchain will be increasingly applied across all economic sectors, including agribusiness, promoting greater reliability and agility in information with a reduced cost. Several gaps for future studies were observed, with significant value for science, industry, and society.

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