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. FINDINGS 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) INTERPRETATION 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. FUNDING Austrian Council for Research and Technology Development, Austrian Federal Ministry of Science, Research Economy, and European Research Council Advanced Grant DEMOVE.
The Lancet