Research Article| Volume 50, SUPPLEMENT 5, S137-S140, December 2019

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What microsurgeon, orthopaedic and plastic surgeon should know about bionic hand

Published:October 21, 2019DOI:


      Hand loss is a catastrophic event that generates significant demands for orthopedics and prosthetics. In the course of history, prostheses evolved from passive esthetic replacements to sophisticated robotic hands. Yet, their actuation and particularly, their capacity to provide patients with sensations, remain an unsolved problem. Sensations associated with the hand, such as touch, pain, pressure and temperature detection are very important, since they enable humans to gather information from the environment. Recently, through a synergistic multidisciplinary effort, medical doctors and engineers have attempted to address these issues by developing bionic limbs. The aim of the bionic hands is to replace the amputated hands while restoring sensation and reintroducing hand-motor control. Recently, several different approaches have been made to interface this sophisticated prosthesis with residual neuro-muscular structures. Different types of implants, such as intramuscular, epineural and intraneural, each have their own complementary advantages and disadvantages, which are discussed in this paper. After initial trials with percutaneous leads, present research is aimed at making long-term implantable electrodes that give rich, natural feedback and allow for effortless control. Finally, a pivotal part in the development of this technology is the surgical technique which will be described in this paper. The surgeons’ insights into this procedure are given. These kinds of prostheses compared with the classic one, hold a promise of dramatic health and quality of life increase, together with the decrease the rejection rate.


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        • Rang M.
        Amputations and prostheses in he story of orthopaedics.
        WB Sounders Co. Philadelphia, London, Sydney, Toronto2000: 293-305
        • Clement R.G.E.
        • Bugler K.E.
        • Oliver C.W.
        Bionic prosthetic hands: a review of present technology and future aspirations.
        Surgeon. 2011; 9: 336-340
      1. Amputee Coalition. Limb Loss Statistics (and references therein). 2017

        • Grob M.
        • Papadopulos N.A.
        • Zimmermann A.
        • Biemer E.
        • Kovacs L.
        The psychological impact of severe hand injury.
        J. Hand Surg. (European). 2008; 33: 358-362
        • Weber D.J.
        • Friesen R.
        • Miller L.E.
        Interfacing the somatosensory system to restore touch and proprioception: essential considerations.
        J. Mot. Behav. 2012; 44: 403-418
        • Dubernard J.M.
        • Henry P.
        • Parmentier H.
        • et al.
        First transplantation of two hands: results after 18 months.
        Ann. Chir. 2000; 127: 19-25
        • Brandbacher G.
        • Ninkovic M.
        • Pitza-Karter H.
        • Gabl M.
        • Hussl H.
        • Rieger M.
        • et al.
        The Insbruck hand transplantation program: update at 8 years after first transplantation.
        Tranplant. Proc. 2009; 41: 491-494
        • Petruzzo P.
        • Lanzetta M.
        • Dubernard J.M.
        • Landin L.
        • Cavadas P.
        • Margreiter R.
        • Schneeberger S.
        • Breidenbach W.
        • Kaufman C.
        • Jablecki J.
        • Schuind F.
        • Dumontier C.
        The international registry on hand and composite tissue transplantation.
        Transplantation. 2010; 90: 1590
        • Rauschmann M.A.
        • Heine M.C.
        • Thomann K.D.
        The German Orthopedics Society 1918-1932. Developments and trends.
        Orthopade. 2001; 30: 685-695
        • Bernstein F.
        Prosthetic manhood in the Soviet Union at the end of world war II.
        Osiris. 2015; 30: 113-133
        • Raspopovic S.
        • Petrini F.M.
        • Zelechowski M.
        • Valle G.
        Framework for the development of neuroprostheses: from basic understanding by sciatic and median nerves models to bionic legs and hands.
        Proc. IEEE. 2017; 105: 34-49
        • Aszmann O.C.
        • Roche A.D.
        • Salminger S.
        • et al.
        Bionic reconstruction to restore hand function after brachial plexus injury: a case series of three patients.
        Lancet. 2015; 385: 2183-2189
        • Raspopovic S.
        • Capogrosso M.
        • Petrini F.M.
        • Bonizzato M.
        • Rigosa J.
        • Di Pino G.
        • Carpaneto J.
        • Controzzi M.
        • Boretius T.
        • Fernandez E.
        • Granata G.
        • Oddo C.M.
        • Citi L.
        • Ciancio A.L.
        • Cipriani C.
        • Carrozza M.C.
        • Jensen W.
        • Guglielmelli E.
        • Stieglitz T.
        • Rossini P.M.
        • Micera S.
        Restoring natural sensory feedback in real-time bidirectional hand prostheses.
        Sci. Transl. Med. 2014; 6 (222ra19)
        • Oddo C.M.
        • Raspopovic S.
        • Artoni F.
        • Mazzonia
        • Spigler G.
        • Petrini F.
        • Giambattistelli F.
        • Vecchi F.
        • Miraglia F.
        • Zollo L.
        • Di Pino G.
        • Camboni D.
        • Carrozza M.C.
        • Guglielmelli E.
        • Rossini P.M.
        • Faraguna U.
        • Micera S.
        Intraneural stimulation elicits discrimination of texture features by artificial fingertip in the intact and amputee humans.
        Elife. 2017; : 1-27
        • Tan D.W.
        • Schiefer M.A.
        • Keith M.W.
        • et al.
        A neural interface provides long-term stable natural touch perception.
        Sci Transl. Med. 2014; (257ra138)
        • Ortiz-Catalan M.
        • Håkansson B.
        • Brånemark R.
        An osteointegrated human-machine gateway for long-term sensory feedback and motor control of artificial limbs.
        Sci. Transl. Med. 2014; 6: 257
        • Flor H.
        Phantom-limb pain: characteristics, causes, and treatment.
        Lancet Neurology. 2002; 1: 182-189
        • Pasquina P.F.
        • Evangelista M.
        • Carvalho A.J.
        • Lochart J.
        • Griffin S.
        • Nanos G.
        • McKay P.
        • Hansen N.
        • Ipsen D.
        • Vandersea J.
        • Butkus J.
        • Miller M.
        • Murphy I.
        • Hankin D.
        First-in-man demonstration of a fully implanted myoelectric sensors system to control an advanced electromechanical prosthetic hand.
        J. Neurosci. Methods. 2014; 10: 7-16
        • Davis T.S.
        • et al.
        Restoring motor control and sensory feedback in people with upper extremity amputations using arrays of 96 microelectrodes implanted in the median and ulnar nerves.
        J. Neural. Eng. 2016; 13.3 (036001)
        • Kuiken T.A.
        • Miller L.A.
        • Lipschutz R.D.
        • et al.
        Targeted reinnervation for enhanced prosthetic arm function in a woman with a proximal amputation: a case study.
        Lancet. 2007; 369: 371-380
        • Marasco P.D.
        • Shultz A.E.
        • Kuiken T.A.
        Sensory capacity of reinervated skin after redirection of amputated upper limb nerves to the chest.
        Brain. 2009; 132: 1441-1448