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

J Hand Surg Am. 2019 Feb;44(2):163.e1-163.e5. doi: 10.1016/j.jhsa.2018.04.009. Epub 2018 Jun 19.

Abstract

Control of independent digital flexion and extension has remained an elusive goal in myoelectric prosthetics for upper extremity amputees. We first performed a cadaver study to determine the feasibility of transferring the interossei muscles for each digit to the dorsum of the hand without damaging the neurovascular pedicles. Once this capability was ensured, a clinical case was performed transferring the interossei of the middle and ring fingers to the dorsum of the hand where they could serve as a myoelectric signal for a partial hand amputee to allow individual digital control with a myoelectric prosthesis. Before surgery, it was impossible to detect an independent signal for each interossei; however, after the surgery, signals were reliably detected, which allowed these muscles to serve as myosites for finger flexion using a myoelectric prosthesis and move each digit independently. This concept of salvaging innervated and perfused muscles from an amputated part and transferring them into the more proximal and superficial portion of a salvaged limb has broad applications for improved myoelectric prosthetic control.

Keywords: Amputation; electromyographic signal; interossei muscle transfer; myoelectric control; prosthesis.

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Adaptation, Physiological
  • Adult
  • Amputation, Traumatic / surgery
  • Amputees / rehabilitation
  • Artificial Limbs*
  • Degloving Injuries / surgery
  • Electromyography*
  • Finger Injuries / surgery
  • Fingers / innervation*
  • Humans
  • Male
  • Muscle, Skeletal / innervation*
  • Muscle, Skeletal / surgery*
  • Prosthesis Design
  • Visual Analog Scale