The project
New methods in the treatment of limb amputations, aimed at the application of bionic prostheses. An original approach to the problems associated with prosthetic control in patients with proximal upper limb amputations has been developed in recent years thanks to the Targeted Muscle Reinnervation (TMR) technique, developed by Todd Kuiken and Gregory Dumanian of Northwestern University in Chicago (Kuiken et al. 2013). TMR is a relatively complex procedure that combines available prosthetic technology with anatomical modification of the residual limb. TMR is centrally based on orthopedic and neurosurgical intervention, but this is based on a strong neurophysiological indication and requires subsequent training and patient monitoring by the neurologist and rehabilitation therapist, in close collaboration with the prosthetic fitter. The TMR surgical technique involves transferring the stumps of the main nerves of the upper limb (median, ulnar, radial, and musculocutaneous) to new target muscles that have lost their original function (for example, the pectoralis major in patients with shoulder disarticulation). Before being reinnervated, the target muscles are denervated of their native motor innervation, allowing the transferred nerve to reinnervate them more easily. The target muscles are then used as "biological amplifiers" of the nerve signals from the motor nerves that originally controlled the amputated region. By transferring multiple motor nerves to different areas of the pectoralis major, the myoelectric signal collected after TMR allows for simultaneous and more intuitive control of advanced prostheses with a large number of active joints. The anatomical areas corresponding to the muscles reinnervated during TMR, if appropriately stimulated, can also be used to transmit tactile information relating to the missing limb, since the relocated nerves are composed of both efferent and afferent fibers. The objectives and purposes of the trial are: evaluating the effectiveness of the TMR procedure in achieving reinnervation of the target muscles necessary for prosthetic control; evaluating the safety of the TMR procedure by monitoring side effects and any major complications specifically associated with the type of procedure; defining a pre- and post-operative rehabilitation protocol aimed at achieving effective prosthetic control; defining the clinical-care pathway for the application of TMR to patients with upper limb amputations and evaluating the possibility of providing this treatment in the future.
