Bionic artificial limb – amazing surgery performed at Maria Cecilia Hospital

Maria Cecilia Hospital part of GVM Care & Research and located in Ravenna, is one of the few centers in Europe to carry out this complex neurosurgical technique in which an operation is performed to control an artificial limb, specifically a bionic arm.

“It is estimated that there are over 3,000 cases of upper limb amputation in Italy every year, due to pathologies or traumatic events. Prosthetics offer a new quality of life for the patients, thanks to the evolution of technology and ever more performing materials. Wearing a prosthesis is like turning on the light: it’s not just a matter of screwing in the bulb, the “electrical cables” must also be connected correctly.

In fact, the patients need to learn how to use properly the prosthesis. This ability requires a long process of preparation and rehabilitation,

Often, surgery for adequate neuro-muscular “connections” is required as well. The TMR (Targeted Muscle Reinnervation) technique serves precisely this purpose.

In Italy, Dr. Guido Staffa is the pioneer in the application of the TMR technique. He’s a neurosurgeon specialized in peripheral nervous system surgery at Maria Cecilia Hospital in Cotignola (Ravenna) a highly specialized hospital accredited with the Italian National Healthcare System. In the last 4 years, 7 TMR procedures have been performed in Italy (there are about fifty in the world), all supervised by Dr. Staffa and his team.

“The purpose of the TMR technique is to create the conditions for the prosthetic implant – explains Dr. Staffa –. Years ago I was part of an amputee study group. The implanted electric prostheses were not used well by the patients, since an unusual contraction of muscles is necessary to perform the specific movement of the prosthesis. In fact, our brain refuses to use movements other than those for which it was designed. Therefore, with the aim of obtaining the activation of these muscles, it was decided to implant the nerves of the residual part of the amputation, i.e. those that remained in the stump. Thus the human limit is bypassed, defined as the body schema, or rather the memory of the brain which is not able to naturally activate the prosthesis according to what are the needs”.

A recent case is that of Davide, a boy who had undergone an amputation of the proximal 3rd humerus with disarticulation (the whole limb was removed including the shoulder joint) due to a motorcycle accident when he was only 16 years old. This type of amputation is particularly favorable to the TMR technique and the operation took place about a year after the accident to restore functionality to the nerves that still had potential. The team led by Dr. Staffa is part of the Neurosurgery Unit of Maria Cecilia Hospital directed by Dr. Ignazio Borghesi.

In a nutshell, the operation consists in freeing the nerves from post-traumatic scar adhesions and connecting the nerves that controlled the function of the lost limb with the muscles of the shoulder-chest region. These target muscles will then function as a signal amplifier for the electrodes of the prosthesis. The TMR allows to improve the control of the prosthesis and facilitate the rehabilitation process of the patient. The reinnervated muscle is subsequently tested through a rehabilitation process and a physiological study to apply sensors that detect the electrical impulse to be transmitted to the prosthesis. The path for the patient lasts about 2 years, including pre- operative rehabilitation preparation, the operation, post-operative rehabilitation and also long- term follow-up and rehabilitation and training in the use of the prosthesis”.

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