Life-changing Medical Marvels — Medical advancement for an amputation

OrthoCarolina hand surgeons bringing new hope to amputee victims.

Interviews By Rebecca Alberico

In a transformational medical advancement for people who may have suffered an amputation, two Charlotte, N.C., OrthoCarolina hand surgeons are pioneering a procedure that offers patients unparalleled use of their upper extremities following an amputation. OrthoCarolina is one of the United States’s leading orthopedic practices for comprehensive orthopedic care.

The doctors’ procedure is called Targeted Muscle Reinnervation (TMR), and it transplants nerves and allows them to “reinnervate,” or grow into, another muscle. This allows nerve signals which have been transferred into a new muscle, say a forearm, to control the prosthetic device as a normal human arm would, using nerve impulses sent directly from the brain.

“Even when a limb is gone, nerves are still available for the body to use,” says Dr. Glenn Gaston, who along with Dr. Bryan Loeffler has been developing this new technique as a significant advancement for amputee patients. “Reassigning nerves to another part of the limb gives a patient easier control of their prosthesis and can also significantly reduce the phantom pain often felt by amputees.”

“Phantom pain” is a significant issue for amputees — you may have lost a foot, but your brain could still be signalling that you have pain in that foot.

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Simply put, this TMR procedure being developed by Drs. Gaston and Loeffler allows upper extremity amputees the ability to learn to work with a new prosthetic device by utilizing the remaining nerves in the arm to operate the device, just like nerve signals from the brain allow us to use our hands. The doctors have performed approximately 15 successful below-the-elbow surgeries to date.

One of their most notable TMR patients is a 32-year-old mother of three, Tiffany Johnson, who lost her right arm when she was bitten by a shark while snorkelling off the Bahamas this past June. The surgeons amputated Johnson’s arm just below the elbow joint — and this was extremely significant. By amputating below the elbow joint, the doctors could ensure functional and sustained use of her right arm.

“What’s incredible is if you lost your arm 10 years ago, that nerve is still there and it’s still capable of sending a signal to your brain” — Dr. Glenn Gaston

Despite the badly damaged muscles and skin of Johnson’s right arm, the doctors transferred nerves that controlled the hand from the severed limb into another part of the arm, then reinserted those nerves into another muscle.

In their new location, and through the strength of the new muscle, Johnson’s nerves can function as they would have previously — and she is in the process of learning to use her new myoelectric hand, which is controlled by signals from the brain, just as her hand was controlled previously before amputation.

Most importantly, Dr. Gaston stresses that the TMR procedure does not have to be performed at the time of the accident or amputation; it can take place years later. “What’s incredible is if you lost your arm 10 years ago, that nerve is still there and it’s still capable of sending a signal to your brain,” says Dr. Gaston. “We can do this even decades later for patients and achieve the same result.”

This forward-thinking and innovative Targeted Muscle Reinnervation procedure is just the beginning for Drs. Gaston and Loeffler, who are also developing other forms of TMR by adapting the principles to other parts of the body, including the forearms and legs. They also completed the first surgery for a prosthetic hand with an individual finger control in 2016.

What’s more is that OrthoCarolina has a Reconstructive Center for Lost Limbs, a clinic for amputee patients that gathers once per month. This gives the doctors a chance to check in with patients and gives the amputee patients a chance to socialize. “Most patients don’t know anybody who has gone through what they have gone through, but then once a month they meet with 30 other people who know exactly what they’re going through and you see them talking about everything,” says Dr. Gaston. “It’s very therapeutic for amputee patients to be there monthly, and it’s one of the clinics we most look forward to.”

One of America’s leading orthopedic practices for comprehensive orthopedic care, OrthoCarolina’s slogan is, “You. Improved.”

For Tiffany Johnson and potentially many, many more, the work of Drs. Glenn Gaston and Bryan Loeffler are bringing that slogan to life.

photos courtesy of orthocarolina

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