A Novel Muscle Transfer for Independent Digital Control of a Myoelectric Prosthesis: The Starfish Procedure

Gaston, R. Glenn; Bracey, John W.; Tait, Mark; Loeffler, Bryan J.

doi:10.1016/j.jhsa.2018.04.009

Cited by 25 publications

(17 citation statements)

References 7 publications

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“…Finally, as new surgical techniques develop, so will indications for TMR versus transfers of existing musculature for prosthetic and pain control. Already, it is possible for metacarpal level amputees to obtain excellent finger function with the starfish procedure, in which existing interosseous muscles are dorsally transposed to create a reliable myoelectric signal [31] . In this same patient, a sensory neuroma may be resected and the nerve coapted to a motor nerve to the volar interosseous for pain control.…”

Section: Upper Extremity Tmr -Future Directionsmentioning

confidence: 99%

Expanding the top rungs of the extremity reconstructive ladder: targeted muscle reinnervation, osseointegration, and vascularized composite allotransplantation

2020

Plast Aesthet Res

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Osseointegration (OI), targeted muscle reinnervation (TMR), and vascularized composite allotransplantation (VCA) are just a few ways by which our reconstructive ladder is evolving. It is important to recognize that amputation does not necessarily denote failure, but surgeons should strive to find ways to provide these patients with means for obtaining better satisfaction and quality of life postoperatively. TMR and OI have added options for mutilating lower extremity injuries that necessitate amputation. More recently, the senior author (Levin LS) described the "penthouse" floor of the reconstructive ladder being VCA. Despite the advances in VCA over the last 20 years, there are many challenges that face this discipline including indications for patient selection, minimizing immunosuppressive regimens, standardizing outcome measures, establishing reliable protocols for monitoring, and diagnosing and managing rejection. Herein, the authors review TMR, OI, and VCA as additional higher rungs of the reconstructive ladder.

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Section: Upper Extremity Tmr -Future Directionsmentioning

confidence: 99%

Expanding the top rungs of the extremity reconstructive ladder: targeted muscle reinnervation, osseointegration, and vascularized composite allotransplantation

2020

Plast Aesthet Res

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“…The recently developed starfish procedure transfers retained intrinsic musculature in partial hand amputations to improve myoelectric signaling and permit individual prosthetic digit control. 8 We have modified this concept to be applicable to transhumeral amputations, which we call the “octopus procedure” based on the appearance of the muscles when dissected in the proximal forearm. The octopus procedure is a novel technique that combines the principles of TMR and/or regenerative peripheral nerve interfaces to increase available EMG signals for heightened prosthetic control while minimizing potential RLP/PLP in the transhumeral amputee.…”

Section: Introductionmentioning

confidence: 99%

The Octopus Procedure Combined with Targeted Muscle Reinnervation for Elective Transhumeral Amputation

Agrawal¹,

Olafsson

Pickrell

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Summary: Optimizing prosthetic function and tolerance are key principles of performing an elective upper extremity amputation. It is common for upper extremity amputees to experience issues related to nonoptimal prosthetic control and pain. Targeted muscle reinnervation and regenerative peripheral nerve interfaces in elective transhumeral amputations have been introduced as techniques to address the paucity of signals that may exist for myoelectric control postamputation. These techniques require the denervation of muscle and rely on delayed muscle reinnervation to provide eventual signal amplification for prosthetic function. In addition, the fascicles cannot be separated enough to provide signals to each individual muscle. Use of native innervated forearm musculature can provide more immediate and specific signals for prosthetic use. These native muscles are often not available for use due to trauma, denervation, or dysvascularization. In elective amputations, they can be used as spare parts to provide more signals for the sensors on a myoelectric prosthetic. The concept has been used in partial hand amputations and allowed for individual digital control at the terminal prosthetic device. In this study, we describe a novel technique used for an elective transhumeral amputation utilizing native innervated, vascularized musculature to provide intuitive control of a myoelectric prosthetic.

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“…When multiple muscles and sensors are in close proximity, the signal produced by one muscle can be accidentally detected by a nearby sensor resulting in unwanted motions (ie, myoelectric cross-talk). 9 By increasing the distance between individual sensors, or by placing nonmuscular, local soft tissues between target muscles, one can improve signal strength and clarity and decrease myoelectric crosstalk. The concept of reclaiming muscles with retained nerve and blood supply that are residing too deep to be detected by surface electrodes and transferring them into a more superficial location has the potential to significantly increase available signals for myoelectric detection and, therefore, function.…”

mentioning

confidence: 99%

“…The concept of reclaiming muscles with retained nerve and blood supply that are residing too deep to be detected by surface electrodes and transferring them into a more superficial location has the potential to significantly increase available signals for myoelectric detection and, therefore, function. 9 It is with these thoughts in mind, that the authors began investigating a novel technique to transfer the remaining viable hand intrinsic muscles to a dorsal and superficial position to enable intuitive, individual digital control of a myoelectric prosthesis. This procedure has been termed the Starfish procedure.…”

mentioning

confidence: 99%

The Starfish Procedure

Niedermeier

Gaston

Loeffler

2021

Techniques in Orthopaedics

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Partial hand amputations are devastating injuries, which can significantly impact ability to work and activities of daily living. Prosthetics can improve function for amputees; however, prosthesis utilization rates have historically been low in this patient population. Prosthetics for partial hand amputees can be active, passive, or driven by myoelectric signals. Myoelectric prosthetics have a role in dramatically improving patient function, but intuitive control of these prosthetics has not been possible. Frustration with ability to control these prosthetics, and an inability to control individual digits contributes to low utilization rates for these patients. The Starfish procedure was developed to provide patients with an intuitive ability to control individual myoelectric digits on a partial hand prosthesis.

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A Novel Muscle Transfer for Independent Digital Control of a Myoelectric Prosthesis: The Starfish Procedure

Cited by 25 publications

References 7 publications

Expanding the top rungs of the extremity reconstructive ladder: targeted muscle reinnervation, osseointegration, and vascularized composite allotransplantation

Expanding the top rungs of the extremity reconstructive ladder: targeted muscle reinnervation, osseointegration, and vascularized composite allotransplantation

The Octopus Procedure Combined with Targeted Muscle Reinnervation for Elective Transhumeral Amputation

The Starfish Procedure

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