1. Amputation and Optimization

2. Reconstruction and Limb Salvage

1. Amputation and Optimization

2. Reconstruction and Limb Salvage

1. Targeted Muscle Reinnervation (TMR)

   • What is it?

     1. Targeted muscle reinnervation (TMR) is a procedure for patients undergoing limb amputation or those with painful neuromas after nerve injury. When a nerve is cut or injured, it tries to regrow. Without a clear target, this can create a tangled mass of nerve tissue called a neuroma.

     2. TMR involves redirecting severed or injured nerves to new muscle targets using microsurgery. This gives the nerves a new muscle to connect with, encouraging organized regrowth and reducing the risk of painful neuroma formation and phantom limb pain.

     3. During amputation, peripheral nerves are cut, which can lead to neuromas or phantom limb pain. TMR can be done during or after amputation to prevent painful neuromas and reduce phantom limb pain.

     4. Additionally, TMR can improve control of certain prosthetics, called myoelectric prosthetics. It can be done at the time of amputation or later.

     5. Painful neuromas can occur after any peripheral nerve injury. If other treatments fail, neuromas can be surgically removed. After removal, TMR can be performed to reduce the risk of the neuroma returning.

   • Who is a candidate?

     1. Individuals with acquired or congenital limb loss suffering from nerve pain or phantom limb sensation

     2. Individuals with painful neuropathy or neuromas

2. Regenerative Peripheral Nerve Interface (RPNI)

   • What is it?

     1. Regenerative peripheral nerve interface (RPNI) surgery is for patients undergoing limb amputation or those with painful neuromas after nerve injury.

     2. When a nerve is cut or injured, it tries to regrow. Without a clear target, this can create a tangled mass of nerve tissue called a neuroma.

     3. RPNI surgery involves taking small muscle grafts from the body and placing them over severed nerve endings. This provides the nerves with new muscle to connect to, encouraging organized regrowth and reducing the risk of painful neuromas.

     4. During amputation, peripheral nerves are cut, which can lead to neuromas or phantom limb pain. RPNI surgery can be done during or after amputation to prevent painful neuromas and reduce phantom limb pain.

     5. Additionally, RPNI surgery can improve control of certain prosthetics. It can be done at the time of amputation or later.

     6. Painful neuromas can occur after any peripheral nerve injury. If other treatments fail, neuromas can be surgically removed. After removal, RPNI surgery can be performed to reduce the risk of the neuroma returning.

3. Osseointegration (also known as bone anchored prosthesis or osseous integration limb replacement)

   1. What is Osseointegration (O.I.)?

Osseointegration is the process of bone growing into a metal implant. This involves surgically anchoring an artificial implant into the bone, which then integrates with the implant. This technique is most commonly used in dental implants and joint replacement surgery. It has been highly successful in these applications and has recently been applied to the field of amputation to anchor prostheses directly to the bone.

2. Why O.I.? 

• Eliminates need for a socket

  • Your prosthesis will be directly connected to your bone. For lower limb, this means more natural walking mechanics and weight applied on your bone as opposed to your skin, muscle and soft tissue. This avoids all of the common problems of a socket including: blistering, sweating, skin breakdown and avoids the constant need for new sockets to be made by your prosthetist. For upper limb, in addition to these benefits, having a bone anchored prosthesis reduces the need for strapping and suction devices to hold your prosthesis in place. 

• Improved mobility and ambulation

  • By restoring a more normal ambulation or upper limb use, function improves and daily activity tasks are easier

• Increased limb awareness (proprioception and osseoperception)

  • Due to the more secure connection of the prosthesis to the body, people enjoy an improved sense of stability and are able to tell the surfaces they are walking on (osseoperception) and telling where their limbs are in space (proprioception)

• Quicker and easier donning and doffing

  • Under 10 seconds of donning and doffing

  • Increased stability

  • No need for additional tools 

• Decreases nerve pain

  • O.I. has been shown to decrease nerve and phantom pain by restoring more normal function and ambulation

3. Who is a candidate?

   • Patients with:

     1. Recurrent skin issues or ulcers

     2. Pain

     3. Short residual limb length

     4. Scarring/Skin Grafts

     5. Excessive Sweating

     6. Restricted Mobility

     7. Ages 22-65

     8. Under 100 kg/220 lbs.

4. Why Two Stage?

   • The OPRA™ Implant System for individuals with transfemoral amputations requires two surgeries, three months apart to insert the components into the residual limb and allow for proper bone anchoring. The three months healing allows for a strong bone bond to form. Within three weeks following the second surgery the individual begins the rehabilitation process. In about 90 days from this point the rehabilitation should be complete and amputees can use their bone anchored prosthesis without limitations. 
     

5. What to expect

   • Initial Recovery Period

• Overview: After osseointegration surgery, patients can expect to stay in the hospital for a few days. The initial recovery period focuses on managing pain and preventing infection.

• Wound Care: Proper wound care is essential. Patients will receive instructions on how to keep the surgical site clean and dry to prevent infection.

• Physical Activity: Limited physical activity is recommended. Patients should avoid putting pressure on the surgical site and follow the guidance of their healthcare team.

• Time in between surgeries

  • Staging the Process: Osseointegration surgery typically involves two stages. The first stage involves the insertion of the implant into the bone. After this, a period of 3 months is required for the bone to grow around the implant, a process called osseointegration.

  • Monitoring Progress: Regular check-ups are necessary during this period to monitor the healing process. X-rays and other imaging techniques may be used to ensure the bone is integrating well with the implant.

• Follow up appointments

  • Regular Check-Ups: Follow-up appointments are crucial to monitor healing and address any concerns. These appointments ensure that the implant is integrating well and that there are no complications.

• Rehabilitation and Physical Therapy

  • Starting Rehabilitation: Physical/occupational therapy is essential for building strength and improving mobility.Patients will be given a tailored exercise program to enhance their recovery. This includes exercises to improve flexibility, strength, and balance.

• Prosthetic Evaluation

  1. At the Center for Amputation Reconstruction, we are committed to providing personalized care for each of our patients. We conduct an in-depth prosthetic evaluation to understand and address the unique needs and goals of every individual. This comprehensive assessment allows us to tailor prosthetic solutions that optimize functionality, comfort, and quality of life. Our dedicated team of specialists ensures that each patient receives a prosthetic device that is meticulously designed and fitted to support their specific lifestyle and mobility requirements.

  2. Types of prosthetic devices: [Need more info, need pictures/videos]

     • Partial Hand Prosthesis

       1. Passive

       2. Body Powered

       3. External-powered designs

     • Lower

1. What is Osseointegration (O.I.)?

Osseointegration is the process of bone growing into a metal implant. This involves surgically anchoring an artificial implant into the bone, which then integrates with the implant. This technique is most commonly used in dental implants and joint replacement surgery. It has been highly successful in these applications and has recently been applied to the field of amputation to anchor prostheses directly to the bone.

2. Why O.I.? 

• Eliminates need for a socket

  • Your prosthesis will be directly connected to your bone. For lower limb, this means more natural walking mechanics and weight applied on your bone as opposed to your skin, muscle and soft tissue. This avoids all of the common problems of a socket including: blistering, sweating, skin breakdown and avoids the constant need for new sockets to be made by your prosthetist. For upper limb, in addition to these benefits, having a bone anchored prosthesis reduces the need for strapping and suction devices to hold your prosthesis in place. 

• Improved mobility and ambulation

  • By restoring a more normal ambulation or upper limb use, function improves and daily activity tasks are easier

• Increased limb awareness (proprioception and osseoperception)

  • Due to the more secure connection of the prosthesis to the body, people enjoy an improved sense of stability and are able to tell the surfaces they are walking on (osseoperception) and telling where their limbs are in space (proprioception)

• Quicker and easier donning and doffing

  • Under 10 seconds of donning and doffing

  • Increased stability

  • No need for additional tools 

• Decreases nerve pain

  • O.I. has been shown to decrease nerve and phantom pain by restoring more normal function and ambulation

3. Who is a candidate?

   • Patients with:

     1. Recurrent skin issues or ulcers

     2. Pain

     3. Short residual limb length

     4. Scarring/Skin Grafts

     5. Excessive Sweating

     6. Restricted Mobility

     7. Ages 22-65

     8. Under 100 kg/220 lbs.

4. Why Two Stage?

   • The OPRA™ Implant System for individuals with transfemoral amputations requires two surgeries, three months apart to insert the components into the residual limb and allow for proper bone anchoring. The three months healing allows for a strong bone bond to form. Within three weeks following the second surgery the individual begins the rehabilitation process. In about 90 days from this point the rehabilitation should be complete and amputees can use their bone anchored prosthesis without limitations. 

5. What to expect

   • Initial Recovery Period

• Overview: After osseointegration surgery, patients can expect to stay in the hospital for a few days. The initial recovery period focuses on managing pain and preventing infection.

• Wound Care: Proper wound care is essential. Patients will receive instructions on how to keep the surgical site clean and dry to prevent infection.

• Physical Activity: Limited physical activity is recommended. Patients should avoid putting pressure on the surgical site and follow the guidance of their healthcare team.

• Time in between surgeries

  • Staging the Process: Osseointegration surgery typically involves two stages. The first stage involves the insertion of the implant into the bone. After this, a period of 3 months is required for the bone to grow around the implant, a process called osseointegration.

  • Monitoring Progress: Regular check-ups are necessary during this period to monitor the healing process. X-rays and other imaging techniques may be used to ensure the bone is integrating well with the implant.

• Follow up appointments

  • Regular Check-Ups: Follow-up appointments are crucial to monitor healing and address any concerns. These appointments ensure that the implant is integrating well and that there are no complications.

• Rehabilitation and Physical Therapy

  • Starting Rehabilitation: Physical/occupational therapy is essential for building strength and improving mobility. Patients will be given a tailored exercise program to enhance their recovery. This includes exercises to improve flexibility, strength, and balance.