Targeted reinnervation for transhumeral amputees: current surgical technique and update on results
Abstract
BACKGROUND: Targeted reinnervation in upper extremity transhumeral amputees can improve control and dexterity of myoelectric prostheses. The operation as described previously required a long residual limb and the presence of a brachialis muscle. METHODS: Brachial plexus dissections were performed to confirm and better understand the branching pattern of the radial nerve in the upper arm. A simplified surgical approach for targeted reinnervation in transhumeral amputees was devised. This study reports on the first six transhumeral amputees who have undergone this simplified procedure. RESULTS: The long and lateral heads of the triceps receive distinct and separate motor nerves from the proximal radial nerve. This anatomy allows a nerve transfer of the distal radial nerve to the motor nerve of the lateral head of the triceps without injury to the innervation of the long head of the triceps. The median nerve transfer to the motor branch of the medial head of the biceps is performed on the anterior surface of the arm as described previously. All six patients had successful targeted reinnervation procedures using this simplified approach. CONCLUSION: Targeted reinnervation for transhumeral amputees can now be performed in patients with amputations at the level of the middle of the humerus or longer.
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TR has demonstrated success in improving motor control signals for both transhumeral and shoulder disarticulation amputation.
“It has demonstrated a success in improving the motor control signals for both transhumeral and shoulder disarticulation amputation (Dumanian et al., 2009).”
From Selectivity and Longevity of Peripheral-Nerve and Machine Interfaces: A Review. (2017) · cites this paper as Dumanian et al., 2009
Cites
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Self-citationKuiken, T., Miller, L. A., Lipschutz, R. D., Lock, B. A., Stubblefield, K. A., Marasco, P. D., Zhou, P., & Dumanian, G. A. (2007) · The Lancet · doi:10.1016/s0140-6736(07)60193-7 · Cited by 477 · see citing works
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The effect of subcutaneous fat on myoelectric signal amplitude and cross-talk
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Self-citationImproved Myoelectric Prosthesis Control Accomplished Using Multiple Nerve Transfers
Hijjawi, J. B., Kuiken, T., Lipschutz, R. D., Miller, L. A., Stubblefield, K. A., & Dumanian, G. A. (2006) · Plastic & Reconstructive Surgery · doi:10.1097/01.prs.0000242487.62487.fb · Cited by 157 · see citing works
Self-citationTargeted Reinnervation to Improve Prosthesis Control in Transhumeral Amputees
O’Shaughnessy, K. D., Dumanian, G. A., Lipschutz, R. D., Miller, L. A., Stubblefield, K. A., & Kuiken, T. (2008) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.g.00268 · Cited by 122 · see citing works
Self-citationThe hyper-reinnervation of rat skeletal muscle
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Self-citationIndependence of myoelectric control signals examined using a surface emg model
Lowery, M. M., Stoykov, N. S., & Kuiken, T. (2003) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2003.812152 · Cited by 58 · see citing works
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Targeted Muscle Reinnervation: A Novel Approach to Postamputation Neuroma Pain
Souza, J. M., Cheesborough, J. E., Ko, J. H., Cho, M. S., Kuiken, T. A., & Dumanian, G. A. (2014) · Clinical Orthopaedics & Related Research · doi:10.1007/s11999-014-3528-7 · Cited by 407 · see citing works
Self-citationRobotic touch shifts perception of embodiment to a prosthesis in targeted reinnervation amputees
Marasco, P. D., Kim, K., Colgate, J. E., Peshkin, M. A., & Kuiken, T. A. (2011) · Brain · doi:10.1093/brain/awq361 · Cited by 335 · see citing works
Self-citationToward higher-performance bionic limbs for wider clinical use
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Self-citationHargrove, L. J., Miller, L. A., Turner, K., & Kuiken, T. A. (2017) · Scientific Reports · doi:10.1038/s41598-017-14386-w · Cited by 190 · see citing works
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Selectivity and Longevity of Peripheral-Nerve and Machine Interfaces: A Review.
Ghafoor, U., Kim, S., & Hong, K.-S. (2017) · Frontiers in Neurorobotics · doi:10.3389/fnbot.2017.00059 · Cited by 88 · see citing works
“It has demonstrated a success in improving the motor control signals for both transhumeral and shoulder disarticulation amputation (Dumanian et al., 2009).”
Irwin, Z. T., Schroeder, K. E., Vu, P. P., Tat, D. M., Bullard, A. J., Woo, S. L., Sando, I. C., Urbanchek, M. G., Cederna, P. S., & Chestek, C. A. (2016) · Journal of Neural Engineering · doi:10.1088/1741-2560/13/4/046007 · Cited by 78 · see citing works
Innovations in Prosthetic Interfaces for the Upper Extremity
Kung, T. A., Bueno, R. A., Alkhalefah, G. K., Langhals, N. B., Urbanchek, M. G., & Cederna, P. S. (2013) · Plastic and Reconstructive Surgery · doi:10.1097/prs.0b013e3182a97e5f · Cited by 71 · see citing works
- Authors
- Dumanian, G. A., Ko, J. H., O’Shaughnessy, K. D., Kim, P. S., Wilson, C. J., & Kuiken, T. A.
- Affiliations
- Northwestern University (US)
- Shirley Ryan AbilityLab (US)
- Brooke Army Medical Center (US)
- Venue
- Plastic and Reconstructive Surgery
- Published
- 2009-09
- Volume
- 124
- Issue
- 3
- Pages
- 863-869
- ISSN
- 0032-1052 (ISSN-L)
- OpenAlex
- W1974066308
- Cited by
- 130
- References
- 9
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 9 · 2023: 6 · 2022: 7 · 2021: 16 · 2020: 11 · 2019: 12 · 2018: 8 · 2017: 10 · 2016: 10 · 2015: 5 · 2014: 9 · 2013: 8 · 2012: 4
- FWCI
- 1.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Plastic & Reconstructive Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neural Engineering
- Physical Sciences › Engineering › Biomedical Engineering › Muscle activation and electromyography studies
- Health Sciences › Medicine › Surgery › Nerve Injury and Rehabilitation
- Keywords
- transhumeral amputation, myoelectric prosthesis, median nerve transfer, biceps brachii, brachial plexus, nerve transfer
- MeSH terms
- Amputation Stumps, Artificial Limbs, Electromyography, Humans, Median Nerve, Motor Neurons, Nerve Transfer, Muscle, Skeletal, Upper Extremity
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