Amputation treatments are often demolitive, performed in urgency or even in emergency. This results in an inadequate stump poorly functional and painful, which considerably hinder the success of the prosthetic treatment. The philosophy behind the traditional amputation technique is to create an ideal accommodation for the stump on the socket, conceiving the stump as a passive support for the prosthesis. This lead to great difficult in the aim to create a stump capable to control an advanced robotic prostheses. In the context of preparing the upper limb stump with the aim of applying an advanced robotic prostheses, this experimentation has three specific objectives: 1. Reproduce the most effective techniques, such as TMR (Targeted Muscle Reinnervation) and osseointegration. This arises from the request to have a center where this type of procedure is carried out systematically. 2. Making improvements to the aforementioned surgical techniques also by implementing sensitive feedback with the aim of closing the loop. 3. Use the innovations made in order to demonstrate experimentally the improvement in functionality. We enrolled 2 patients. The first patient was a young woman who underwent TMR surgery for the application of a bionic prosthesis after a shoulder disarticulation in 2018. She suffered important phantom limb syndrome which required important drug therapy and was unsatisfied of her traditional prostheses. After the TMR surgery the patient had no more need to take painkiller therapy. Furthermore she controlled all the DOF of a robotic prostheses in an intuitive and independent manner. The second patient was a young man who underwent a combined intervention of osseointegration, TMR and TSR in September 2019. The goal was to bring innovations to the amputation surgery technique. After carrying out an in-depth study of the possibilities of innovation, it was decided to make the following changes with respect to ordinary techniques: to combine the TMR and the two times for osseointegration in a single intervention. This made it possible to reduce the time and stress due to three surgeries for the patient. We reported that in an adequate surgical time, it is possible to carry out the operation without reporting complications, demonstrating that the technique is safe, feasible and repeatable on a larger scale. The other, and main, innovation was that of having performed a TSR in which the thumb fascicle of the median nerve was transferred to the medial cutaneous nerve of the forearm with the aim of recreating a skin area dedicated to the thumb on the patient's stump. This, when appropriately stimulated, may have an important functional relevance especially in functions where right-hand manipulation is required such as, for example, pinch. Currently, the patient has already cosmetic prosthetic system with connection to the osseointegrated implant. Compared to the previous one, the patient reports greater ease in being worn and removed for this prosthesis (in the order of 1-2 minutes). In addition, he reported greater freedom of movement of the shoulder, which he considered very limited when he was wearing his previous prosthesis due to the bracing system used to fix it to the abutment, also states that the skin of the abutment is no longer irritated with the new fixing system. It is interesting to note that the difficult application to the abutment and the limitation to the movement of the arm of the prosthesis previously used were among the reasons that led the patient to undertake the experimental path. At the end of the training course it is planned to provide a myoelectrically controlled prosthesis to the patient. In conclusion, both of surgeries ended with no complications for patients. Unfortunately, due to the COVID-19 emergency, the application phase of the final prosthesis has been delayed, but the prosthesis are packaged and are currently ready. Therefore, after the end of the health emergency, the patients will be able use the final advanced robotic prosthesis.

Novel methods to rearrange the upper limb stump aimed to physically and informationally interface bionic prostheses / Lorenzo Alirio Diaz Balzani - : . , 2021 Jun 16. ((33. ciclo

Novel methods to rearrange the upper limb stump aimed to physically and informationally interface bionic prostheses

2021-06-16

Abstract

Amputation treatments are often demolitive, performed in urgency or even in emergency. This results in an inadequate stump poorly functional and painful, which considerably hinder the success of the prosthetic treatment. The philosophy behind the traditional amputation technique is to create an ideal accommodation for the stump on the socket, conceiving the stump as a passive support for the prosthesis. This lead to great difficult in the aim to create a stump capable to control an advanced robotic prostheses. In the context of preparing the upper limb stump with the aim of applying an advanced robotic prostheses, this experimentation has three specific objectives: 1. Reproduce the most effective techniques, such as TMR (Targeted Muscle Reinnervation) and osseointegration. This arises from the request to have a center where this type of procedure is carried out systematically. 2. Making improvements to the aforementioned surgical techniques also by implementing sensitive feedback with the aim of closing the loop. 3. Use the innovations made in order to demonstrate experimentally the improvement in functionality. We enrolled 2 patients. The first patient was a young woman who underwent TMR surgery for the application of a bionic prosthesis after a shoulder disarticulation in 2018. She suffered important phantom limb syndrome which required important drug therapy and was unsatisfied of her traditional prostheses. After the TMR surgery the patient had no more need to take painkiller therapy. Furthermore she controlled all the DOF of a robotic prostheses in an intuitive and independent manner. The second patient was a young man who underwent a combined intervention of osseointegration, TMR and TSR in September 2019. The goal was to bring innovations to the amputation surgery technique. After carrying out an in-depth study of the possibilities of innovation, it was decided to make the following changes with respect to ordinary techniques: to combine the TMR and the two times for osseointegration in a single intervention. This made it possible to reduce the time and stress due to three surgeries for the patient. We reported that in an adequate surgical time, it is possible to carry out the operation without reporting complications, demonstrating that the technique is safe, feasible and repeatable on a larger scale. The other, and main, innovation was that of having performed a TSR in which the thumb fascicle of the median nerve was transferred to the medial cutaneous nerve of the forearm with the aim of recreating a skin area dedicated to the thumb on the patient's stump. This, when appropriately stimulated, may have an important functional relevance especially in functions where right-hand manipulation is required such as, for example, pinch. Currently, the patient has already cosmetic prosthetic system with connection to the osseointegrated implant. Compared to the previous one, the patient reports greater ease in being worn and removed for this prosthesis (in the order of 1-2 minutes). In addition, he reported greater freedom of movement of the shoulder, which he considered very limited when he was wearing his previous prosthesis due to the bracing system used to fix it to the abutment, also states that the skin of the abutment is no longer irritated with the new fixing system. It is interesting to note that the difficult application to the abutment and the limitation to the movement of the arm of the prosthesis previously used were among the reasons that led the patient to undertake the experimental path. At the end of the training course it is planned to provide a myoelectrically controlled prosthesis to the patient. In conclusion, both of surgeries ended with no complications for patients. Unfortunately, due to the COVID-19 emergency, the application phase of the final prosthesis has been delayed, but the prosthesis are packaged and are currently ready. Therefore, after the end of the health emergency, the patients will be able use the final advanced robotic prosthesis.
Bionics; amputation surgery; robotic prosthesis
Novel methods to rearrange the upper limb stump aimed to physically and informationally interface bionic prostheses / Lorenzo Alirio Diaz Balzani - : . , 2021 Jun 16. ((33. ciclo
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.12610/68697
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