Page 9 - Mecklenburg_Medicine_April-2018

Once confirmed, the terminal portion of each metacarpal is resected to allow sufficient NEW MEMBERS

room for the prosthetic componentry and to make the prosthetic digits match the natural finger Ingrid S. Bullard, MD
Obstetrics and Gynecology
lengths. The desired interossei are then mobilized from the metacarpals while maintaining nerve Novant Health Rankin OB/GYN
1918 Randolph Road #670
and blood supply. These muscles then are transferred to a subcutaneous location on the dorsum Charlotte, NC 28207
704-384-1620
of the hand. Soft tissue interpositions then are created and placed between the transferred East Carolina University, 2000

interossei to create a buffer between the individual interosseous muscles. This minimizes Charles Edwin
Stoddard III, MD
myoelectric cross-talk between the transferred The opportunity to Nephrology
muscles and allows cleaner signal detection by Metrolina Nephrology Associates
433 Copperfield Boulevard NE
the surface electrodes. salvage muscles that Concord, NC 28025
With this technique, each preserved 704-786-7770
retain their nerve and Medical University of South
interosseous muscle will contract when the blood supply and transfer Carolina, 2001
patient attempts to initiate digital flexion of the
corresponding finger. The muscle contraction Nady Hamid, MD
Orthopaedic Surgery
generates a myoelectric signal that can be them proximally into the OrthoCarolina
detected by a surface electrode, which transmits 1915 Randolph Road
residual limb to allow Charlotte, NC 28207
the signal to the prosthetic digit. When the increased highly intuitive 704-323-3190
prosthetic digit receives that signal it flexes thus University of Alabama, 2005
producing the patient’s desired function. Because
Upcoming
each transferred muscle corresponds to a single myoelectric signals Meetings
finger and each muscle has its own sensor and
has broad potential APRIL
prosthetic finger, individual digital control is applications for improved
possible. (Figures 2 &3) Meetings are at the MCMS office unless
otherwise noted.
Results
At the OrthoCarolina Reconstructive Center prosthetic function. n Tuesday, April 10
for Lost Limbs, we now have performed seven MedLink meeting
Community Care Partners of Greater
Starfish procedures for partial hand amputees, Mecklenburg
4701 Hedgemore Drive, Charlotte
ranging from two to four fingers lost. In all cases, robust palpable and detectable signals were 8:30 a.m.

detected immediately following surgery. Patients demonstrated the ability to naturally control n Friday, April 13
Child Health Committee meeting
each prosthetic finger in a highly intuitive manner even at the two-week post-op visit. The 7:30 a.m.

index patient now is over two years from surgery and is capable of natural independent finger n Monday, April 16
Executive Committee meeting
motion. He can both pick a flower and lift a 20lb dumbbell. He is the first-ever patient with 6 p.m.

individual digital control of a prosthetic following a partial hand amputation. n Thursday, April 19
CAMGMA Social
The Future Time and Location TBD

Following the Starfish procedure, the transferred muscles provide independent signals n Monday, April 23
to power individual digital control of a myoelectric hand prosthesis. This concept of June magazine deadline
salvaging muscles with remaining nerve and blood supply from a mangled extremity
and transferring them into a more proximal location during amputation has the potential
to markedly enhance available signals for myoelectric detection and hence function.
This technique has the potential to create similar individual digital control for even more
proximal level amputations. Our cadaveric study demonstrates the potential for applying
this concept to more proximal level amputations including the potential for a myoelectric
hand with all five digits capable of independent control. This could potentially be
performed even at the level of the distal forearm amputation. The opportunity to salvage
muscles that retain their nerve and blood supply and transfer them proximally into the
residual limb to allow increased highly intuitive myoelectric signals has broad potential
applications for improved prosthetic function.

Enhancing Care for Patients With Upper Extremity Amputations

An increasing volume of patients with upper extremity amputations, coupled with innovative
surgical and technological advancements, as well as a passion for the care of these patients led
Drs. Gaston and Loeffler to found the OrthoCarolina Reconstructive Center for Lost Limbs
(www.orthocarolina.com/RCLL). This monthly clinic provides multidisciplinary care and an
opportunity for social support to amputees from the region and across the nation with surgeons,
prosthetists, and therapists collaborating to maximize quality and efficiency of care.

Mecklenburg Medicine • April 2018 | 9