Tag Archives: Surgery

The New Surgery that is Perfecting Prosthetics

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Picture of a bright orange and yellow starfish with legs in the process of regenerationThink about your daily morning routine: rolling over in bed, reaching with your hand to turn on your bedside lamp, rising slowly to make breakfast, showering, dropping your bottle of shampoo, picking it up with your hand, brushing your teeth while holding the handle with all five fingers, and getting dressed, tying your shoes by wrapping the laces around your fingers to finish the double knot. Maybe you go to work and lift heavy objects or sit at a computer to organize files for your company, licking your fingertip every time you flip through a folder of papers.

Now, imagine this routine with three fewer fingers on your dominant hand. There would be three fewer fingers to grasp your tooth brush or pull on your shirt. Should you have a desk job or one consisting of manual labor, your ability to efficiently do work diminishes.

Thirty-nine-year-old Eddie Chapman became someone who had to confront this imagined setback when he was in an accident at his job, losing his middle, ring, and little finger in a machinery malfunction. This accident made him one of the nearly two million living amputees in America. Not only did the amputation create physical difficulty in Eddie’s life as he could no longer complete the manual labor required at his job, it also caused mental barriers by creating a lack of self-esteem and confidence in his everyday actions. He could no longer accomplish the simple things he once could.

Eddie planned on receiving a myoelectric prosthetic, which uses small sensors implanted in the patient’s stump to transfer the natural electric signals from muscles to power the movement of the artificial limb. However, it has been noted by a variety of medical journals for decades that myoelectric prosthetics can be unreliable due to a concept called cross-talk.

During this cross-talk, the intricate muscular system of the hand forces these sensors to be placed close together, sometimes creating overlap or misinterpretation of signals. These faulty signals ultimately result in unwanted or incorrect prosthetic movement. In the case of trans metacarpal (partial hand) amputees, the muscles between the fingers meeting in the knuckle area were found to be causing the majority of this signal-error problem.

To combat this cross-talk of signals, doctors in Charlotte, North Carolina – Glenn Gaston and Bryan Loeffler – worked together with coworkers at OrthoCarolina and nearby HangerClinic prosthetic company to successfully develop a new surgery: the Starfish Procedure. This procedure helped Eddie along with six other partial hand amputees to regain their confidence and their lifestyles.

During this new and innovative surgery, the muscles with excess proximity in the hand (the ones causing the cross-talk) are dissected apart and placed in locations farther apart from each other. This results in greater likelihood of independent detection by the myoelectric sensors while maintaining nerve and blood supply at the same time. With the success in this surgery, the disruption and lack of accuracy in signal interpretation is drastically decreased. The name of the surgery, “Starfish Procedure,” comes from the appearance of the muscles mid-dissection resembling the body of a starfish, as shown in the image below, and the animal’s association with regeneration after losing limbs.

PIcture of metacrapal muscles mid-dissection resembling a similar shape to a starfish

Picture of muscles mid-dissection during the Starfish Procedure

This surgery was completed seven times with no failure, showing promise for its future development. However, some experts doubt the predicted success of exploring the procedure with more proximal amputations because of the procedure’s high cost and the uncertainty of the prediction from lack of research. In 2016, there was a recorded 40% abandonment rate of myoelectric, showing a current issue with myoelectric rejection in these cases where amputation occurs further up on the limb.

The process of finding the surgery’s viability in these instances has already begun with researchers Bergmeister, Konstantin D, et al. conducting and reporting on a large animal study. His study explored the function of myoelectric prosthetics in four sheep and twenty-four rats with full limb amputations. Not only did the study conclude successful implantation and machine function of the electrodes in all animals involved in the study, it also showed the possibility of myoelectric function working better in more proximal amputations.

The muscles involved with myoelectric sensors in higher level amputees (most of/ full limb removal) are larger and more spread out than those associated with digit amputation in the hand, so there is less expected cross-talk between signals in the former. This large animal study shows that the Starfish Procedure may be different and less invasive, thus less expensive, while still achieving optimal control in prosthesis.

If given the proper resources to explore the surgery’s potential in more severe amputation cases, the Starfish Procedure could revolutionize the field of prosthetics. The reliability of the myoelectric product would be enhanced, and amputees would regain higher levels of functionality. They would get the small elements of their daily lifestyles back. They would be able to hold their toothbrush upright, tie a double knot, and pick up that slippery bottle of shampoo.

In an interview six months post-surgery, Eddie Chapman explained his increased sense of self-esteem following the procedure’s success. At two years post-op, Eddie can lift 20-pound dumbbells with his partially prosthetic hand, and he could not be happier. The Starfish Procedure’s success in improving the functionality of Eddie and the six other partial hand amputees shows that there is promise for further development of the procedure in more severe amputation cases.

With advanced exploration of this ground-breaking procedure’s potential, even more of the two million amputees in the nation can improve upon their prosthetic functionality as well.

By: K. Burgess

References:

“Amputee Hand Surgery: The Starfish Procedure.” OrthoCarolina, 23 Apr. 2018, www.orthocarolina.com/media/a-breakthrough-in-medical-care-the-starfish-procedure.

Bergmeister, Konstantin D, et al. “Prosthesis Control with an Implantable Multichannel Wireless Electromyography System for High-Level Amputees: A Large-Animal Study.” Plastic and Reconstructive Surgery, Vol. 137, Iss. 1: pp 153–162, U.S. National Library of Medicine, PubMed, Jan. 2016, https://journals.lww.com/plasreconsurg/fulltext/2016/01000/Prosthesis_Control_with_an_Implantable.30.aspx.

Chadwell, Alix, et al. “The Reality of Myoelectric Prostheses: Understanding What Makes These Devices Difficult for Some Users to Control.” Frontiers in Neurorobotics, Vol. 10, Iss. 7, Frontiers Media S.A., 22 Aug. 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4992705/pdf/fnbot-10-00007.pdf.

Gaston, R. Glenn, et al. “A Novel Muscle Transfer for Independent Digital Control of a Myoelectric Prosthesis: The Starfish Procedure.” The Journal of Hand Surgery, Vol. 44, Iss. 2, pp 163.e1-163.e5, W.B. Saunders, February 2019, www.sciencedirect.com/science/article/pii/S0363502317314429.

Geethanjali, Purushothaman. “Myoelectric Control of Prosthetic Hands: State-of-the-Art Review.” Medical Devices (Auckland, N.Z.), Vol. 9, pp. 247-55, Dove Medical Press, 27 July 2016,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4968852/.

Image Credits:

Image 1: Boyer, Massimo, “Sea Star Regenerating Arms,” https://plantandanimaladaptations.weebly.com/sea-star-5-arms.html

Image 2: Clinical Image from “A Novel Muscle Transfer for Independent Digital Control of a Myoelectric Prosthesis: The Starfish Procedure.,” https://www.sciencedirect.com/science/article/pii/S0363502317314429?via%3Dihub

 

 

The One Eye Want

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Photo from Flickr Images

Blue eyes are frequently found in nationalities located near the Baltic sea in northern Europe, and uncommon in places in Asia. Photo from Flickr Images.

Sabrina Shah

Do you yourself have dark brown eyes? Have you ever wished to have vibrant-colored irises? Have you ever invested in colored contacts? Imagine being able to have the bright blue colored lenses you’ve always wanted, permanently. Only about 8 percent of the human population has blue eyes. What if you could be one of that 8 percent?

The idea of cosmetic eye color alteration procedures that was once only seen in sci-fi films and novels is now a reality. With the latest technology, labs in California and India are permanently changing people’s eye color with great rates of success and ease.

The initial discovery of the ability to change one’s eye color was a result of a scientific fluke. It started in 2007 when a glaucoma patient, a 56-year-old Caucasian man, was undergoing experimental treatments. After doctors used a laser procedure in hopes of curing the man’s glaucoma, they discovered his eyes had changed in hue to a bright blue color —an unexpected side effect.

Upon the realization that the eye color change did no damage to the man’s iris after long-term observation, and that it resulted in an aesthetic change, scientist started research and development to create a similar surgery to use for cosmetic purposes to offer to the general public.

Under every brown eye is a blue eye. A Californian lab, STROMA, developed a technique of eye color change on this very idea. Scientists in this lab have created a non-invasive laser method that is pointed at a specific spot in the iris, the “sweet spot”, that causes gradual pigment-tissue degeneration over the course of a few weeks that eventually reveals the blue hue that is present under every brown eye.

This operation has occurred so far only in California and clinical trials have been done on 20 individuals in one eye each to see the success rates and possible long term side effects. So far the operation has yielded great success and no issues have come up however, one known flaw is that the procedure only works to turn brown eyes blue, and furthermore, the blue hue varies in shade depending on the individual’s own base blue eye pigment.

This surgery is not yet available to the general public however, the lab offers an application process to be a participant in their trials; participants are able to get the operation done in one eye and they must attend follow-up consultations to see the effectiveness and potential side effects of the surgery before the lab is able to release the procedure for public consumption.

A different technique in its trial stages is a permanent implantation of a colored lens over the iris. The procedure, so far, has only had one trial performed on a New Zealand woman; the surgery took place in a lab in India.

This procedure is invasive as it requires a physical cut and insertion of a lens over the iris however, it is more manipulable; surgeons are able to change any base eye color to any other desired eye color, much like colored contact lenses do. During the procedure, doctors implant a colored artificial lens over the person’s natural eye color. The color change is immediate much like colored contacts but without the hassle of having to remove the contacts on a nightly basis.

No negative side affects have been noted by the New Zealand participant thus far, and the surgery was successful in altering her brown eyes to her desired shade of bright teal blue. Further observation is being carried out in order to ensure the safety and permanence of the implants. Surgeons want to ensure that the lenses will not need to be replaced and that they do not have issues with movement within the eye, years after the procedure. This lab did not offer any opportunity to register as an experimental participant, and is only observing the one known participant so far. It is not yet offered on the market to the masses.

The implications of these two surgeries are potentially monumental.

The lens implantation surgery can be used for people who are afflicted with genetic diseases such as albinism, birth defects that cause a lack of iris pigmentation, and other individuals who lack color in their irises for unexplained biological reasons, since the surgery is able to change any one eye color to another. With the implantation method, people who lack pigment in the iris will be able to get any color lenses implanted over their own colorless lenses.

Both procedures, STROMA and lens implantation, can also be used on people who just do not like their dark eyes and want an everlasting eye color change. Imagine plastic surgery/body modification for the eye balls.

This new technology may be the very future of body modification for people around the world. Although it is not available in the market yet, once it is tried and tested by experimenters and health agencies, eye color alteration may become the next big obsession in first world nations that strive to attain physical beauty.

Since only about 8 percent of the population has blue eyes, colored eyes are vied for by people in places where blue eyes are uncommon, like Asia where the colored contacts industry is particularly booming. Marketing for these procedures will most likely take place in regions with high frequency of brown eyes (55 percent of the population of the world currently, has brown eyes). These procedures will likely decrease that statistic dramatically.

After these surgeries become established procedures, what body part do you think will be up for modification next?

Medical Technology May Be Getting Way Too A-“head”

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Enjoy Furigay

Has medical technology become advanced enough to make fiction fact and dreams reality? Has medicine made enough developments to defy the almighty transcendent? With the possibility of a human head transplant being performed in the near future, there have been speculations of the creation of an “artificial” individual like the monster from Mary Shelley’s book, Frankenstein.

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Many attempts at artificial transplants of organs such as the skin, liver, and heart have been successful. For example, a revolutionary medical event occurred when Patrick Hardison, a 41 year old firefighter who suffered from severe burns, was able to receive a full face transplant surgery in August 2015.

Figure 1. The progression of Patrick Hardison’s face after the surgery.

Therefore, why can’t a head transplant become viable with the rapidly evolving technology of the modern era?

Surprisingly, a head transplant was already performed by a group of neurosurgeons led by Dr. Robert White in the 1970s. The team was able to transplant the head of a living rhesus monkey into the body of a beheaded rhesus monkey through rapid stitching of both entities. However, this experiment could only loosely be called a success.

Figure 2. The head of the rhesus monkey during the surgery.

When it awoke after the surgery, the head had expressions of great pain, confusion, and anxiety. With the disconnection of the spinal nerve fibers, the monkey could only react to stimuli, smell, hear, taste, and see. However, it was not able to digest the food it was given and was paralyzed from the neck down. After eight days in this dismal state, the body’s immune system rejected the transplant and the monkey met its end.

In conclusion, Frankenstein’s monster could not have a pet monkey.

Despite the warning of not repeating a head transplant from Dr. Jerry Silver, a neurologist who participated in Dr. White’s surgery, an Italian neuroscientist from the Turin Advanced Neuromodulation Group named Dr. Sergio Canavero plans to perform a human head transplant in December 2017, which is only about two years away.

Figure 3. Dr. Canavero in his TED Talk.

Canavero believes in Dr. White’s statement that “…with the significant improvements in surgical techniques and postoperative management … it is possible to consider adapting the head-transplant technique to humans.” This modern day Dr. Frankenstein has outlined a possible procedure called HEAVEN-GEMINI that will allow for the connection of the donor’s and recipient’s spinal cords.

The head anastomosis venture, or HEAVEN-GEMINI, is a complex surgical procedure that involves the cooling and cutting of both the recipient’s and donor’s spinal cords in a way that would allow anastomosis to occur. To spare you of the confusing and complex medical terminology Canavero uses in his outline, I will summarize the procedure here:

Anastomosis is simply “a surgical connection between two structures,” which in this case, are the brain and the spine. This would allow for minimal tissue damage and nerve fusion that was not a component of Dr. White’s rhesus monkey surgery. Grey matter interneuronal networks, or in other words, the networks in the spine that relay information to the body, are kept functional during and after surgery with low level electrical stimulation.

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To keep the body healthy, different types of support such as anesthesiologic and thermal will be given to both the donor and recipient during the surgery. Canavero outlines the procedures to be followed post-surgery, also.

After the surgery, the individual must remain sedated in a cervical collar under intensive care for maximum recovery. When the individual wakes up, measures need to be taken in order for him or her to get used to the new body and establish their identity. The healthcare team responsible for the individual must maintain a positive relationship with him or her to ensure intellectual and emotional growth and help during times of stress and anxiety that can be related to the procedure, recovery, and/or the new body. We wouldn’t want the individual to be in an unstable emotional state like Frankenstein’s monster, right?

The concept of HEAVEN-GEMINI does seem viable. Canavero explains in elaborate detail the steps of procedure and the conditions that have to be met for the surgery to be successful. This shows that he is knowledgeable about this topic and the medical field overall. Theoretically, the surgery will allow the patient to function normally due to the connection between the spinal cord and brain instead of being immobile and unable to eat like the rhesus monkey in Dr. White’s experiment. In addition to that statement, the recipient may be able to live a prolonged life, instead of just a few days. Furthermore, this procedure doesn’t use the elementary technology of Dr. White’s time. Canavero will use cutting-edge technology to fuse the head and body together, instead of just rapidly stitching them together.

This seems like a medical miracle, right? Cut off some heads, put ‘em in some bodies, and save the day! (Or solve paralysis, at least.)

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It’s not false that this procedure would create great leaps in the medical field. Other than paralysis, this gives amputees the chance to regain their lost body parts and “brain dead” or beheaded victims a second chance at life. Additionally, it could lead to the creation of a superior human. However, a miracle does come with complications.

First, let’s delve into the moral and philosophical issues of this medical wonder. He or she consists of two entities: the donor (body) and the recipient (head). Would the person be one of the two, both, or have a new identity all together? Once the identity issue has been solved, there is the question of how he or she will be treated morally, legally, and socially. Essentially, the patient is a “new being” with this being the first known successful head transplant for any entity. Will the patient follow societal norms or will a new set of rules be made specifically for that individual? The major moral concern of this procedure is the fact that we may be violating God’s will. By performing this experiment, are we trying to exceed the limits a transcendent has put on us? If we are, would this spell doom for humanity?

In addition to these ethical and philosophical questions, many medical doctors and scientists have been skeptical about this procedure. Dr. Thomas Cochrane, a director of neuroethics at Harvard Medical School stated that it will be impossible for Canavero to gather enough evidence to go through with the surgery and that there is no guarantee that the recipient will have a better lifestyle post-surgery. Dr. Michael DeGeorgia, a neurologist at University Hospitals Case Medical Center argues that head transplants may be feasible in the far future, but in decades, not in two years with medical technology as it is now.

Will Frankenstein’s monster be able to have a friend since it couldn’t have a pet?

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In my opinion, hopefully not. (Sorry.) There have been numerous amounts of science fiction movies that emphasize that this is a dangerous idea. I don’t want to deal with the extinction or endangerment of humanity with the creation of a superior being, either.

What’s your opinion? Would you want a second chance at life or do you think Canavero lost his head?

Figure 4. This picture shows a happy Dr. Canavero.