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Senger JL, Thorkelsson A, Wang BY, Chan KM, Kemp SWP, Webber CA. Comparison of 2 Regenerative Peripheral Nerve Interface Techniques for the Treatment of Rat Neuroma Pain. Plast Reconstr Surg 2024; 154:346-349. [PMID: 37400949 DOI: 10.1097/prs.0000000000010911] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
SUMMARY Treatment of painful neuromas has long posed a significant challenge for peripheral nerve patients. The regenerative peripheral nerve interface (RPNI) provides the transected nerve with a muscle graft target to prevent neuroma formation. Discrepancies in RPNI surgical techniques between animal models ("inlay" RPNI) and clinical studies ("burrito" RPNI) preclude direct translation of results from bench to bedside and may account for variabilities in patient outcomes. The authors compared outcomes of these 2 surgical techniques in a rodent model. Animals treated with burrito RPNI after tibial nerve neuroma formation demonstrated no improvement in pain assessment, and tissue analysis revealed complete atrophy of the muscle graft with neuroma recurrence. By contrast, animals treated with inlay RPNI had significant improvement in pain with viable muscle grafts. The results suggest superiority of the inlay RPNI surgical technique for the management of painful neuroma in rodents. CLINICAL RELEVANCE STATEMENT RPNIs are currently being used to prevent and treat neuroma and phantom limb pain. This preclinical study suggests the superiority of one surgical technique over the other.
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Affiliation(s)
- Jenna-Lynn Senger
- From the Department of Surgery
- Division of Plastic and Reconstructive Surgery, University of British Columbia
| | | | - Bonnie Y Wang
- Division of Physical Medicine and Rehabilitation, University of Alberta
| | - K Ming Chan
- Division of Physical Medicine and Rehabilitation, University of Alberta
| | - Stephen W P Kemp
- Department of Surgery, Section of Plastic Surgery
- Department of Biomedical Engineering, University of Michigan
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2
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Zhang B, Hu Y, Du H, Han S, Ren L, Cheng H, Wang Y, Gao X, Zheng S, Cui Q, Tian L, Liu T, Sun J, Chai R. Tissue engineering strategies for spiral ganglion neuron protection and regeneration. J Nanobiotechnology 2024; 22:458. [PMID: 39085923 PMCID: PMC11293049 DOI: 10.1186/s12951-024-02742-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024] Open
Abstract
Cochlear implants can directly activate the auditory system's primary sensory neurons, the spiral ganglion neurons (SGNs), via circumvention of defective cochlear hair cells. This bypass restores auditory input to the brainstem. SGN loss etiologies are complex, with limited mammalian regeneration. Protecting and revitalizing SGN is critical. Tissue engineering offers a novel therapeutic strategy, utilizing seed cells, biomolecules, and scaffold materials to create a cellular environment and regulate molecular cues. This review encapsulates the spectrum of both human and animal research, collating the factors contributing to SGN loss, the latest advancements in the utilization of exogenous stem cells for auditory nerve repair and preservation, the taxonomy and mechanism of action of standard biomolecules, and the architectural components of scaffold materials tailored for the inner ear. Furthermore, we delineate the potential and benefits of the biohybrid neural interface, an incipient technology in the realm of implantable devices. Nonetheless, tissue engineering requires refined cell selection and differentiation protocols for consistent SGN quality. In addition, strategies to improve stem cell survival, scaffold biocompatibility, and molecular cue timing are essential for biohybrid neural interface integration.
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Affiliation(s)
- Bin Zhang
- State Key Laboratory of Digital Medical Engineering, Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital, School of Public Health, Advanced Institute for Life and Health, Jiangsu Province High-Tech Key Laboratory for Bio-Medical Research, Southeast University, Nanjing, 210096, China
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, China
| | - Yangnan Hu
- State Key Laboratory of Digital Medical Engineering, Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital, School of Public Health, Advanced Institute for Life and Health, Jiangsu Province High-Tech Key Laboratory for Bio-Medical Research, Southeast University, Nanjing, 210096, China.
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, China.
| | - Haoliang Du
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing University, Nanjing, 210008, China
| | - Shanying Han
- Department of Otolaryngology Head and Neck Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Lei Ren
- State Key Laboratory of Digital Medical Engineering, Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital, School of Public Health, Advanced Institute for Life and Health, Jiangsu Province High-Tech Key Laboratory for Bio-Medical Research, Southeast University, Nanjing, 210096, China
| | - Hong Cheng
- State Key Laboratory of Digital Medical Engineering, Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital, School of Public Health, Advanced Institute for Life and Health, Jiangsu Province High-Tech Key Laboratory for Bio-Medical Research, Southeast University, Nanjing, 210096, China
| | - Yusong Wang
- State Key Laboratory of Digital Medical Engineering, Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital, School of Public Health, Advanced Institute for Life and Health, Jiangsu Province High-Tech Key Laboratory for Bio-Medical Research, Southeast University, Nanjing, 210096, China
| | - Xin Gao
- State Key Laboratory of Digital Medical Engineering, Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital, School of Public Health, Advanced Institute for Life and Health, Jiangsu Province High-Tech Key Laboratory for Bio-Medical Research, Southeast University, Nanjing, 210096, China
| | - Shasha Zheng
- State Key Laboratory of Digital Medical Engineering, Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital, School of Public Health, Advanced Institute for Life and Health, Jiangsu Province High-Tech Key Laboratory for Bio-Medical Research, Southeast University, Nanjing, 210096, China
| | - Qingyue Cui
- State Key Laboratory of Digital Medical Engineering, Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital, School of Public Health, Advanced Institute for Life and Health, Jiangsu Province High-Tech Key Laboratory for Bio-Medical Research, Southeast University, Nanjing, 210096, China
| | - Lei Tian
- State Key Laboratory of Digital Medical Engineering, Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital, School of Public Health, Advanced Institute for Life and Health, Jiangsu Province High-Tech Key Laboratory for Bio-Medical Research, Southeast University, Nanjing, 210096, China.
| | - Tingting Liu
- State Key Laboratory of Digital Medical Engineering, Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital, School of Public Health, Advanced Institute for Life and Health, Jiangsu Province High-Tech Key Laboratory for Bio-Medical Research, Southeast University, Nanjing, 210096, China.
| | - Jiaqiang Sun
- Department of Otolaryngology-Head and Neck Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, 230001, China.
| | - Renjie Chai
- State Key Laboratory of Digital Medical Engineering, Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital, School of Public Health, Advanced Institute for Life and Health, Jiangsu Province High-Tech Key Laboratory for Bio-Medical Research, Southeast University, Nanjing, 210096, China.
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, China.
- Department of Otolaryngology Head and Neck Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- Department of Neurology, Aerospace Center Hospital, School of Life Science, Beijing Institute of Technology, Beijing, 100081, China.
- Institute for Stem Cell and Regeneration, Chinese Academy of Science, Beijing, China.
- Southeast University Shenzhen Research Institute, Shenzhen, 518063, China.
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3
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Sahalianov I, Abrahamsson T, Priyadarshini D, Mousa AH, Arja K, Gerasimov JY, Linares M, Simon DT, Olsson R, Baryshnikov G, Berggren M, Musumeci C. Tuning the Emission of Bis-ethylenedioxythiophene-thiophenes upon Aggregation. J Phys Chem B 2024; 128:6581-6588. [PMID: 38942741 PMCID: PMC11247477 DOI: 10.1021/acs.jpcb.4c02891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
The ability of small lipophilic molecules to penetrate the blood-brain barrier through transmembrane diffusion has enabled researchers to explore new diagnostics and therapies for brain disorders. Until now, therapies targeting the brain have mainly relied on biochemical mechanisms, while electrical treatments such as deep brain stimulation often require invasive procedures. An alternative to implanting deep brain stimulation probes could involve administering small molecule precursors intravenously, capable of crossing the blood-brain barrier, and initiating the formation of conductive polymer networks in the brain through in vivo polymerization. This study examines the aggregation behavior of five water-soluble conducting polymer precursors sharing the same conjugate core but differing in side chains, using spectroscopy and various computational chemistry tools. Our findings highlight the significant impact of side chain composition on both aggregation and spectroscopic response.
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Affiliation(s)
- Ihor Sahalianov
- Laboratory of Organic Electronics, Department of Science and Technology, Linkoping University, Norrkoping SE-60174, Sweden
- Wallenberg Initiative Materials Science for Sustainability, ITN, Linköping University, Norrköping 60174, Sweden
| | - Tobias Abrahamsson
- Laboratory of Organic Electronics, Department of Science and Technology, Linkoping University, Norrkoping SE-60174, Sweden
| | - Diana Priyadarshini
- Laboratory of Organic Electronics, Department of Science and Technology, Linkoping University, Norrkoping SE-60174, Sweden
| | - Abdelrazek H Mousa
- Department of Chemistry and Molecular Biology, University of Gothenburg, SE-405 30, Gothenburg, Sweden
| | - Katriann Arja
- Laboratory of Organic Electronics, Department of Science and Technology, Linkoping University, Norrkoping SE-60174, Sweden
| | - Jennifer Y Gerasimov
- Laboratory of Organic Electronics, Department of Science and Technology, Linkoping University, Norrkoping SE-60174, Sweden
| | - Mathieu Linares
- Laboratory of Organic Electronics, Department of Science and Technology, Linkoping University, Norrkoping SE-60174, Sweden
- Group of Scientific Visualization, Department of Science and Technology, Linkoping University, Norrkoping SE-60174, Sweden
| | - Daniel T Simon
- Laboratory of Organic Electronics, Department of Science and Technology, Linkoping University, Norrkoping SE-60174, Sweden
| | - Roger Olsson
- Department of Chemistry and Molecular Biology, University of Gothenburg, SE-405 30, Gothenburg, Sweden
- Chemical Biology & Therapeutics, Department of Experimental Medical Science, Lund University, Lund SE-221 84, Sweden
| | - Glib Baryshnikov
- Laboratory of Organic Electronics, Department of Science and Technology, Linkoping University, Norrkoping SE-60174, Sweden
- Wallenberg Initiative Materials Science for Sustainability, ITN, Linköping University, Norrköping 60174, Sweden
| | - Magnus Berggren
- Laboratory of Organic Electronics, Department of Science and Technology, Linkoping University, Norrkoping SE-60174, Sweden
| | - Chiara Musumeci
- Laboratory of Organic Electronics, Department of Science and Technology, Linkoping University, Norrkoping SE-60174, Sweden
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4
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Chang SH, Maenohara Y, Hirose J, Omata Y, Fujiwara S, Haga N, Ikemura M, Saito T, Tanaka S, Matsumoto T. Histopathological Confirmation of Axonal Sprouting in Regenerative Peripheral Nerve Interface. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5878. [PMID: 38855139 PMCID: PMC11161275 DOI: 10.1097/gox.0000000000005878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/17/2024] [Indexed: 06/11/2024]
Abstract
Symptomatic neuroma represents a debilitating complication after major limb amputation. The regenerative peripheral nerve interface (RPNI) has emerged as a reproducible and practical surgery aimed at mitigating the formation of painful neuroma. Although previous animal studies revealed axonal sprouting, elongation, and synaptogenesis of proximal nerve stump within the muscle graft in RPNI, there is a lack of reports confirming these physiological reactions at the histopathological level in human samples. This report presents a case of below-knee amputation with RPNI due to foot gangrene resulting from polyarteritis nodosa. Subsequently, an above-knee amputation was necessitated due to the exacerbation of polyarteritis nodosa, providing the opportunity for histopathological examination of the RPNI site. The examination revealed sprouting, elongation, and existence of neuromuscular junction of the tibial nerve within the grafted muscle. To the best of our knowledge, this is the first report demonstrating axonal sprouting, elongation, and possibility of synaptogenesis of the nerve stump within the grafted muscle in a human sample.
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Affiliation(s)
- Song Ho Chang
- From the Department of Orthopaedic Surgery, Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuji Maenohara
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jun Hirose
- From the Department of Orthopaedic Surgery, Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasunori Omata
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sayaka Fujiwara
- Department of Rehabilitation Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhiko Haga
- Department of Rehabilitation Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masako Ikemura
- Department of Pathology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taku Saito
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takumi Matsumoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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5
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Zbinden J, Earley EJ, Ortiz-Catalan M. Intuitive control of additional prosthetic joints via electro-neuromuscular constructs improves functional and disability outcomes during home use-a case study. J Neural Eng 2024; 21:036021. [PMID: 38489845 DOI: 10.1088/1741-2552/ad349c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/15/2024] [Indexed: 03/17/2024]
Abstract
Objective.The advent of surgical reconstruction techniques has enabled the recreation of myoelectric controls sites that were previously lost due to amputation. This advancement is particularly beneficial for individuals with higher-level arm amputations, who were previously constrained to using a single degree of freedom (DoF) myoelectric prostheses due to the limited number of available muscles from which control signals could be extracted. In this study, we explore the use of surgically created electro-neuromuscular constructs to intuitively control multiple bionic joints during daily life with a participant who was implanted with a neuromusculoskeletal prosthetic interface.Approach.We sequentially increased the number of controlled joints, starting at a single DoF allowing to open and close the hand, subsequently adding control of the wrist (2 DoF) and elbow (3 DoF).Main results.We found that the surgically created electro-neuromuscular constructs allow for intuitive simultaneous and proportional control of up to three degrees of freedom using direct control. Extended home-use and the additional bionic joints resulted in improved prosthesis functionality and disability outcomes.Significance.Our findings indicate that electro-neuromuscular constructs can aid in restoring lost functionality and thereby support a person who lost their arm in daily-life tasks.
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Affiliation(s)
- Jan Zbinden
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Eric J Earley
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Bone-Anchored Limb Research Group, University of Colorado, Aurora, CO, United States of America
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Bionics Institute, Melbourne, Australia
- Medical Bionics Department, University of Melbourne, Melbourne, Australia
- Prometei Pain Rehabilitation Center, Vinnytsia, Ukraine
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6
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Quinn KN, Tian Y, Budde R, Irazoqui PP, Tuffaha S, Thakor NV. Neuromuscular implants: Interfacing with skeletal muscle for improved clinical translation of prosthetic limbs. Muscle Nerve 2024; 69:134-147. [PMID: 38126120 DOI: 10.1002/mus.28029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 11/27/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
After an amputation, advanced prosthetic limbs can be used to interface with the nervous system and restore motor function. Despite numerous breakthroughs in the field, many of the recent research advancements have not been widely integrated into clinical practice. This review highlights recent innovations in neuromuscular implants-specifically those that interface with skeletal muscle-which could improve the clinical translation of prosthetic technologies. Skeletal muscle provides a physiologic gateway to harness and amplify signals from the nervous system. Recent surgical advancements in muscle reinnervation surgeries leverage the "bio-amplification" capabilities of muscle, enabling more intuitive control over a greater number of degrees of freedom in prosthetic limbs than previously achieved. We anticipate that state-of-the-art implantable neuromuscular interfaces that integrate well with skeletal muscle and novel surgical interventions will provide a long-term solution for controlling advanced prostheses. Flexible electrodes are expected to play a crucial role in reducing foreign body responses and improving the longevity of the interface. Additionally, innovations in device miniaturization and ongoing exploration of shape memory polymers could simplify surgical procedures for implanting such interfaces. Once implanted, wireless strategies for powering and transferring data from the interface can eliminate bulky external wires, reduce infection risk, and enhance day-to-day usability. By outlining the current limitations of neuromuscular interfaces along with potential future directions, this review aims to guide continued research efforts and future collaborations between engineers and specialists in the field of neuromuscular and musculoskeletal medicine.
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Affiliation(s)
- Kiara N Quinn
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Yucheng Tian
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ryan Budde
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Pedro P Irazoqui
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sami Tuffaha
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nitish V Thakor
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA
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González-Prieto J, Cristóbal L, Arenillas M, Giannetti R, Muñoz Frías JD, Alonso Rivas E, Sanz Barbero E, Gutiérrez-Pecharromán A, Díaz Montero F, Maldonado AA. Regenerative Peripheral Nerve Interfaces (RPNIs) in Animal Models and Their Applications: A Systematic Review. Int J Mol Sci 2024; 25:1141. [PMID: 38256216 PMCID: PMC10816042 DOI: 10.3390/ijms25021141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Regenerative Peripheral Nerve Interfaces (RPNIs) encompass neurotized muscle grafts employed for the purpose of amplifying peripheral nerve electrical signaling. The aim of this investigation was to undertake an analysis of the extant literature concerning animal models utilized in the context of RPNIs. A systematic review of the literature of RPNI techniques in animal models was performed in line with the PRISMA statement using the MEDLINE/PubMed and Embase databases from January 1970 to September 2023. Within the compilation of one hundred and four articles employing the RPNI technique, a subset of thirty-five were conducted using animal models across six distinct institutions. The majority (91%) of these studies were performed on murine models, while the remaining (9%) were conducted employing macaque models. The most frequently employed anatomical components in the construction of the RPNIs were the common peroneal nerve and the extensor digitorum longus (EDL) muscle. Through various histological techniques, robust neoangiogenesis and axonal regeneration were evidenced. Functionally, the RPNIs demonstrated the capability to discern, record, and amplify action potentials, a competence that exhibited commendable long-term stability. Different RPNI animal models have been replicated across different studies. Histological, neurophysiological, and functional analyses are summarized to be used in future studies.
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Affiliation(s)
- Jorge González-Prieto
- Peripheral Nerve Unit, Department of Plastic Surgery, University Hospital of Getafe, 28905 Madrid, Spain; (J.G.-P.); (L.C.)
- Department of Medicine, Faculty of Biomedical Science and Health, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Lara Cristóbal
- Peripheral Nerve Unit, Department of Plastic Surgery, University Hospital of Getafe, 28905 Madrid, Spain; (J.G.-P.); (L.C.)
- Department of Medicine, Faculty of Biomedical Science and Health, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Mario Arenillas
- Animal Medicine and Surgery Department, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Romano Giannetti
- Institute for Research in Technology, ICAI School of Engineering, Comillas Pontifical University, 28015 Madrid, Spain; (R.G.); (J.D.M.F.)
| | - José Daniel Muñoz Frías
- Institute for Research in Technology, ICAI School of Engineering, Comillas Pontifical University, 28015 Madrid, Spain; (R.G.); (J.D.M.F.)
| | - Eduardo Alonso Rivas
- Institute for Research in Technology, ICAI School of Engineering, Comillas Pontifical University, 28015 Madrid, Spain; (R.G.); (J.D.M.F.)
| | - Elisa Sanz Barbero
- Peripheral Nerve Unit, Neurophysiology Department, University Hospital of Getafe, 28905 Madrid, Spain;
| | - Ana Gutiérrez-Pecharromán
- Peripheral Nerve Unit, Pathological Anatomy Department, University Hospital of Getafe, 28905 Madrid, Spain;
| | - Francisco Díaz Montero
- Department of Design, BAU College of Arts & Design of Barcelona, 28036 Barcelona, Spain;
| | - Andrés A. Maldonado
- Peripheral Nerve Unit, Department of Plastic Surgery, University Hospital of Getafe, 28905 Madrid, Spain; (J.G.-P.); (L.C.)
- Department of Medicine, Faculty of Biomedical Science and Health, Universidad Europea de Madrid, 28670 Madrid, Spain
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8
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Yi J, Zou G, Huang J, Ren X, Tian Q, Yu Q, Wang P, Yuan Y, Tang W, Wang C, Liang L, Cao Z, Li Y, Yu M, Jiang Y, Zhang F, Yang X, Li W, Wang X, Luo Y, Loh XJ, Li G, Hu B, Liu Z, Gao H, Chen X. Water-responsive supercontractile polymer films for bioelectronic interfaces. Nature 2023; 624:295-302. [PMID: 38092907 DOI: 10.1038/s41586-023-06732-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 10/10/2023] [Indexed: 12/18/2023]
Abstract
Connecting different electronic devices is usually straightforward because they have paired, standardized interfaces, in which the shapes and sizes match each other perfectly. Tissue-electronics interfaces, however, cannot be standardized, because tissues are soft1-3 and have arbitrary shapes and sizes4-6. Shape-adaptive wrapping and covering around irregularly sized and shaped objects have been achieved using heat-shrink films because they can contract largely and rapidly when heated7. However, these materials are unsuitable for biological applications because they are usually much harder than tissues and contract at temperatures higher than 90 °C (refs. 8,9). Therefore, it is challenging to prepare stimuli-responsive films with large and rapid contractions for which the stimuli and mechanical properties are compatible with vulnerable tissues and electronic integration processes. Here, inspired by spider silk10-12, we designed water-responsive supercontractile polymer films composed of poly(ethylene oxide) and poly(ethylene glycol)-α-cyclodextrin inclusion complex, which are initially dry, flexible and stable under ambient conditions, contract by more than 50% of their original length within seconds (about 30% per second) after wetting and become soft (about 100 kPa) and stretchable (around 600%) hydrogel thin films thereafter. This supercontraction is attributed to the aligned microporous hierarchical structures of the films, which also facilitate electronic integration. We used this film to fabricate shape-adaptive electrode arrays that simplify the implantation procedure through supercontraction and conformally wrap around nerves, muscles and hearts of different sizes when wetted for in vivo nerve stimulation and electrophysiological signal recording. This study demonstrates that this water-responsive material can play an important part in shaping the next-generation tissue-electronics interfaces as well as broadening the biomedical application of shape-adaptive materials.
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Affiliation(s)
- Junqi Yi
- Innovative Center for Flexible Devices (iFLEX), Max Planck-NTU Joint Lab for Artificial Senses, School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
- Institute for Digital Molecular Analytics and Science (IDMxS), Nanyang Technological University, Singapore, Singapore
| | - Guijin Zou
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Jianping Huang
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems Shenzhen Institute of Advanced Technology Chinese Academy of Sciences (CAS) and the Guangdong-Hong Kong-Macao Joint Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen, China
| | - Xueyang Ren
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
- State Key Laboratory of Bioelectronics and Jiangsu Key Laboratory of Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Qiong Tian
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems Shenzhen Institute of Advanced Technology Chinese Academy of Sciences (CAS) and the Guangdong-Hong Kong-Macao Joint Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen, China
| | - Qianhengyuan Yu
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems Shenzhen Institute of Advanced Technology Chinese Academy of Sciences (CAS) and the Guangdong-Hong Kong-Macao Joint Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen, China
| | - Ping Wang
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems Shenzhen Institute of Advanced Technology Chinese Academy of Sciences (CAS) and the Guangdong-Hong Kong-Macao Joint Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen, China
| | - Yuehui Yuan
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Wenjie Tang
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Changxian Wang
- Innovative Center for Flexible Devices (iFLEX), Max Planck-NTU Joint Lab for Artificial Senses, School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Linlin Liang
- Innovative Center for Flexible Devices (iFLEX), Max Planck-NTU Joint Lab for Artificial Senses, School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Zhengshuai Cao
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems Shenzhen Institute of Advanced Technology Chinese Academy of Sciences (CAS) and the Guangdong-Hong Kong-Macao Joint Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen, China
| | - Yuanheng Li
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems Shenzhen Institute of Advanced Technology Chinese Academy of Sciences (CAS) and the Guangdong-Hong Kong-Macao Joint Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen, China
| | - Mei Yu
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems Shenzhen Institute of Advanced Technology Chinese Academy of Sciences (CAS) and the Guangdong-Hong Kong-Macao Joint Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen, China
| | - Ying Jiang
- Innovative Center for Flexible Devices (iFLEX), Max Planck-NTU Joint Lab for Artificial Senses, School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Feilong Zhang
- Innovative Center for Flexible Devices (iFLEX), Max Planck-NTU Joint Lab for Artificial Senses, School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Xue Yang
- Innovative Center for Flexible Devices (iFLEX), Max Planck-NTU Joint Lab for Artificial Senses, School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Wenlong Li
- Institute of Materials Research and Engineering, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Xiaoshi Wang
- Innovative Center for Flexible Devices (iFLEX), Max Planck-NTU Joint Lab for Artificial Senses, School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Yifei Luo
- Institute of Materials Research and Engineering, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Xian Jun Loh
- Institute of Materials Research and Engineering, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Guanglin Li
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems Shenzhen Institute of Advanced Technology Chinese Academy of Sciences (CAS) and the Guangdong-Hong Kong-Macao Joint Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen, China
| | - Benhui Hu
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China.
- Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China.
| | - Zhiyuan Liu
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems Shenzhen Institute of Advanced Technology Chinese Academy of Sciences (CAS) and the Guangdong-Hong Kong-Macao Joint Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen, China.
| | - Huajian Gao
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.
- School of Mechanical and Aerospace Engineering, College of Engineering, Nanyang Technological University, Singapore, Singapore.
| | - Xiaodong Chen
- Innovative Center for Flexible Devices (iFLEX), Max Planck-NTU Joint Lab for Artificial Senses, School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore.
- Institute for Digital Molecular Analytics and Science (IDMxS), Nanyang Technological University, Singapore, Singapore.
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9
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Dehdashtian A, Timek JH, Svientek SR, Risch MJ, Bratley JV, Riegger AE, Kung TA, Cederna PS, Kemp SWP. Sexually Dimorphic Pattern of Pain Mitigation Following Prophylactic Regenerative Peripheral Nerve Interface (RPNI) in a Rat Neuroma Model. Neurosurgery 2023; 93:1192-1201. [PMID: 37227138 DOI: 10.1227/neu.0000000000002548] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/06/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Treating neuroma pain is a clinical challenge. Identification of sex-specific nociceptive pathways allows a more individualized pain management. The Regenerative Peripheral Nerve Interface (RPNI) consists of a neurotized autologous free muscle using a severed peripheral nerve to provide physiological targets for the regenerating axons. OBJECTIVE To evaluate prophylactic RPNI to prevent neuroma pain in male and female rats. METHODS F344 rats of each sex were assigned to neuroma, prophylactic RPNI, or sham groups. Neuromas and RPNIs were created in both male and female rats. Weekly pain assessments including neuroma site pain and mechanical, cold, and thermal allodynia were performed for 8 weeks. Immunohistochemistry was used to evaluate macrophage infiltration and microglial expansion in the corresponding dorsal root ganglia and spinal cord segments. RESULTS Prophylactic RPNI prevented neuroma pain in both sexes; however, female rats displayed delayed pain attenuation when compared with males. Cold allodynia and thermal allodynia were attenuated exclusively in males. Macrophage infiltration was mitigated in males, whereas females showed a reduced number of spinal cord microglia. CONCLUSION Prophylactic RPNI can prevent neuroma site pain in both sexes. However, attenuation of both cold allodynia and thermal allodynia occurred in males exclusively, potentially because of their sexually dimorphic effect on pathological changes of the central nervous system.
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Affiliation(s)
- Amir Dehdashtian
- Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor , Michigan , USA
| | - Jagienka H Timek
- Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor , Michigan , USA
| | - Shelby R Svientek
- Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor , Michigan , USA
| | - Mary Jane Risch
- Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor , Michigan , USA
| | - Jared V Bratley
- Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor , Michigan , USA
| | - Anna E Riegger
- Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor , Michigan , USA
| | - Theodore A Kung
- Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor , Michigan , USA
| | - Paul S Cederna
- Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor , Michigan , USA
- Department of Biomedical Engineering, The University of Michigan, Ann Arbor , Michigan , USA
| | - Stephen W P Kemp
- Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor , Michigan , USA
- Department of Biomedical Engineering, The University of Michigan, Ann Arbor , Michigan , USA
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10
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Hanwright PJ, Suresh V, Shores JT, Souza JM, Tuffaha SH. Current Concepts in Lower Extremity Amputation: A Primer for Plastic Surgeons. Plast Reconstr Surg 2023; 152:724e-736e. [PMID: 37768220 DOI: 10.1097/prs.0000000000010664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the goals of lower extremity reconstruction and identify clinical scenarios favoring amputation. 2. Understand lower extremity amputation physiology and biomechanics. 3. Review soft-tissue considerations to achieve durable coverage. 4. Appreciate the evolving management of transected nerves. 5. Highlight emerging applications of osseointegration and strategies to improve myoelectric prosthetic control. SUMMARY Plastic surgeons are well versed in lower extremity reconstruction for traumatic, oncologic, and ischemic causes. Limb amputation is an increasingly sophisticated component of the reconstructive algorithm and is indicated when the residual limb is predicted to be more functional than a salvaged limb. Although plastic surgeons have traditionally focused on limb salvage, they play an increasingly vital role in optimizing outcomes from amputation. This warrants a review of core concepts and an update on emerging reconstructive techniques in amputee care.
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Affiliation(s)
- Philip J Hanwright
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | - Visakha Suresh
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | - Jaimie T Shores
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | - Jason M Souza
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center
| | - Sami H Tuffaha
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
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11
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Zbinden J, Sassu P, Mastinu E, Earley EJ, Munoz-Novoa M, Brånemark R, Ortiz-Catalan M. Improved control of a prosthetic limb by surgically creating electro-neuromuscular constructs with implanted electrodes. Sci Transl Med 2023; 15:eabq3665. [PMID: 37437016 DOI: 10.1126/scitranslmed.abq3665] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/23/2023] [Indexed: 07/14/2023]
Abstract
Remnant muscles in the residual limb after amputation are the most common source of control signals for prosthetic hands, because myoelectric signals can be generated by the user at will. However, for individuals with amputation higher up the arm, such as an above-elbow (transhumeral) amputation, insufficient muscles remain to generate myoelectric signals to enable control of the lost arm and hand joints, thus making intuitive control of wrist and finger prosthetic joints unattainable. We show that severed nerves can be divided along their fascicles and redistributed to concurrently innervate different types of muscle targets, particularly native denervated muscles and nonvascularized free muscle grafts. We engineered these neuromuscular constructs with implanted electrodes that were accessible via a permanent osseointegrated interface, allowing for bidirectional communication with the prosthesis while also providing direct skeletal attachment. We found that the transferred nerves effectively innervated their new targets as shown by a gradual increase in myoelectric signal strength. This allowed for individual flexion and extension of all five fingers of a prosthetic hand by a patient with a transhumeral amputation. Improved prosthetic function in tasks representative of daily life was also observed. This proof-of-concept study indicates that motor neural commands can be increased by creating electro-neuromuscular constructs using distributed nerve transfers to different muscle targets with implanted electrodes, enabling improved control of a limb prosthesis.
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Affiliation(s)
- Jan Zbinden
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Paolo Sassu
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Orthoplastic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Enzo Mastinu
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Eric J Earley
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Osseointegration Research Consortium, University of Colorado, Aurora, CO, USA
| | - Maria Munoz-Novoa
- Center for Bionics and Pain Research, Mölndal, Sweden
- Center for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Rickard Brånemark
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Orthopaedics, Gothenburg University, Gothenburg, Sweden
- Integrum AB, Mölndal, Sweden
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Bionics Institute, Melbourne, Australia
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12
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Leach GA, Dean RA, Kumar NG, Tsai C, Chiarappa FE, Cederna PS, Kung TA, Reid CM. Regenerative Peripheral Nerve Interface Surgery: Anatomic and Technical Guide. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5127. [PMID: 37465283 PMCID: PMC10351954 DOI: 10.1097/gox.0000000000005127] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 07/20/2023]
Abstract
Regenerative peripheral nerve interface (RPNI) surgery has been demonstrated to be an effective tool as an interface for neuroprosthetics. Additionally, it has been shown to be a reproducible and reliable strategy for the active treatment and for prevention of neuromas. The purpose of this article is to provide a comprehensive review of RPNI surgery to demonstrate its simplicity and empower reconstructive surgeons to add this to their armamentarium. This article discusses the basic science of neuroma formation and prevention, as well as the theory of RPNI. An anatomic review and discussion of surgical technique for each level of amputation and considerations for other etiologies of traumatic neuromas are included. Lastly, the authors discuss the future of RPNI surgery and compare this with other active techniques for the treatment of neuromas.
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Affiliation(s)
- Garrison A. Leach
- From the Department of General Surgery, Division of Plastic Surgery, University of California San Diego, La Jolla, Calif
| | - Riley A. Dean
- From the Department of General Surgery, Division of Plastic Surgery, University of California San Diego, La Jolla, Calif
| | - Nishant Ganesh Kumar
- Section of Plastic and Reconstructive Surgery and the Department of Biomedical Engineering, University of Michigan, Ann Arbor, Mich
| | - Catherine Tsai
- From the Department of General Surgery, Division of Plastic Surgery, University of California San Diego, La Jolla, Calif
| | - Frank E. Chiarappa
- Department of Orthopedic Surgery, University of California San Diego, La Jolla, Calif
| | - Paul S. Cederna
- Section of Plastic and Reconstructive Surgery and the Department of Biomedical Engineering, University of Michigan, Ann Arbor, Mich
| | - Theodore A. Kung
- Section of Plastic and Reconstructive Surgery and the Department of Biomedical Engineering, University of Michigan, Ann Arbor, Mich
| | - Chris M. Reid
- From the Department of General Surgery, Division of Plastic Surgery, University of California San Diego, La Jolla, Calif
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13
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Vu PP, Vaskov AK, Lee C, Jillala RR, Wallace DM, Davis AJ, Kung TA, Kemp SWP, Gates DH, Chestek CA, Cederna PS. Long-term upper-extremity prosthetic control using regenerative peripheral nerve interfaces and implanted EMG electrodes. J Neural Eng 2023; 20:026039. [PMID: 37023743 PMCID: PMC10126717 DOI: 10.1088/1741-2552/accb0c] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/23/2023] [Accepted: 04/06/2023] [Indexed: 04/08/2023]
Abstract
Objective.Extracting signals directly from the motor system poses challenges in obtaining both high amplitude and sustainable signals for upper-limb neuroprosthetic control. To translate neural interfaces into the clinical space, these interfaces must provide consistent signals and prosthetic performance.Approach.Previously, we have demonstrated that the Regenerative Peripheral Nerve Interface (RPNI) is a biologically stable, bioamplifier of efferent motor action potentials. Here, we assessed the signal reliability from electrodes surgically implanted in RPNIs and residual innervated muscles in humans for long-term prosthetic control.Main results.RPNI signal quality, measured as signal-to-noise ratio, remained greater than 15 for up to 276 and 1054 d in participant 1 (P1), and participant 2 (P2), respectively. Electromyography from both RPNIs and residual muscles was used to decode finger and grasp movements. Though signal amplitude varied between sessions, P2 maintained real-time prosthetic performance above 94% accuracy for 604 d without recalibration. Additionally, P2 completed a real-world multi-sequence coffee task with 99% accuracy for 611 d without recalibration.Significance.This study demonstrates the potential of RPNIs and implanted EMG electrodes as a long-term interface for enhanced prosthetic control.
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Affiliation(s)
- Philip P Vu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, United States of America
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Alex K Vaskov
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, United States of America
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI 48109, United States of America
- Robotics Institute, University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Christina Lee
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Ritvik R Jillala
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Dylan M Wallace
- Robotics Institute, University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Alicia J Davis
- University of Michigan Hospital Orthotics & Prosthetics Center Ann Arbor, Ann Arbor, MI 48109, United States of America
| | - Theodore A Kung
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Stephen W P Kemp
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, United States of America
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Deanna H Gates
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, United States of America
- Robotics Institute, University of Michigan, Ann Arbor, MI 48109, United States of America
- School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Cynthia A Chestek
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, United States of America
- Robotics Institute, University of Michigan, Ann Arbor, MI 48109, United States of America
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI 48109, United States of America
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Paul S Cederna
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, United States of America
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI 48109, United States of America
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14
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Farina D, Vujaklija I, Brånemark R, Bull AMJ, Dietl H, Graimann B, Hargrove LJ, Hoffmann KP, Huang HH, Ingvarsson T, Janusson HB, Kristjánsson K, Kuiken T, Micera S, Stieglitz T, Sturma A, Tyler D, Weir RFF, Aszmann OC. Toward higher-performance bionic limbs for wider clinical use. Nat Biomed Eng 2023; 7:473-485. [PMID: 34059810 DOI: 10.1038/s41551-021-00732-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/01/2021] [Indexed: 12/19/2022]
Abstract
Most prosthetic limbs can autonomously move with dexterity, yet they are not perceived by the user as belonging to their own body. Robotic limbs can convey information about the environment with higher precision than biological limbs, but their actual performance is substantially limited by current technologies for the interfacing of the robotic devices with the body and for transferring motor and sensory information bidirectionally between the prosthesis and the user. In this Perspective, we argue that direct skeletal attachment of bionic devices via osseointegration, the amplification of neural signals by targeted muscle innervation, improved prosthesis control via implanted muscle sensors and advanced algorithms, and the provision of sensory feedback by means of electrodes implanted in peripheral nerves, should all be leveraged towards the creation of a new generation of high-performance bionic limbs. These technologies have been clinically tested in humans, and alongside mechanical redesigns and adequate rehabilitation training should facilitate the wider clinical use of bionic limbs.
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Affiliation(s)
- Dario Farina
- Department of Bioengineering, Imperial College London, London, UK.
| | - Ivan Vujaklija
- Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland
| | - Rickard Brånemark
- Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, UK
| | - Hans Dietl
- Ottobock Products SE & Co. KGaA, Vienna, Austria
| | | | - Levi J Hargrove
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA
| | - Klaus-Peter Hoffmann
- Department of Medical Engineering & Neuroprosthetics, Fraunhofer-Institut für Biomedizinische Technik, Sulzbach, Germany
| | - He Helen Huang
- NCSU/UNC Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thorvaldur Ingvarsson
- Department of Research and Development, Össur Iceland, Reykjavík, Iceland
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Hilmar Bragi Janusson
- School of Engineering and Natural Sciences, University of Iceland, Reykjavík, Iceland
| | | | - Todd Kuiken
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA
| | - Silvestro Micera
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pontedera, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pontedera, Italy
- Bertarelli Foundation Chair in Translational NeuroEngineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, BrainLinks-BrainTools Center and Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Agnes Sturma
- Department of Bioengineering, Imperial College London, London, UK
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Dustin Tyler
- Case School of Engineering, Case Western Reserve University, Cleveland, OH, USA
- Louis Stokes Veterans Affairs Medical Centre, Cleveland, OH, USA
| | - Richard F Ff Weir
- Biomechatronics Development Laboratory, Bioengineering Department, University of Colorado Denver and VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
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15
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Roche AD, Bailey ZK, Gonzalez M, Vu PP, Chestek CA, Gates DH, Kemp SWP, Cederna PS, Ortiz-Catalan M, Aszmann OC. Upper limb prostheses: bridging the sensory gap. J Hand Surg Eur Vol 2023; 48:182-190. [PMID: 36649123 PMCID: PMC9996795 DOI: 10.1177/17531934221131756] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/07/2022] [Accepted: 09/22/2022] [Indexed: 01/18/2023]
Abstract
Replacing human hand function with prostheses goes far beyond only recreating muscle movement with feedforward motor control. Natural sensory feedback is pivotal for fine dexterous control and finding both engineering and surgical solutions to replace this complex biological function is imperative to achieve prosthetic hand function that matches the human hand. This review outlines the nature of the problems underlying sensory restitution, the engineering methods that attempt to address this deficit and the surgical techniques that have been developed to integrate advanced neural interfaces with biological systems. Currently, there is no single solution to restore sensory feedback. Rather, encouraging animal models and early human studies have demonstrated that some elements of sensation can be restored to improve prosthetic control. However, these techniques are limited to highly specialized institutions and much further work is required to reproduce the results achieved, with the goal of increasing availability of advanced closed loop prostheses that allow sensory feedback to inform more precise feedforward control movements and increase functionality.
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Affiliation(s)
- Aidan D. Roche
- College of Medicine, The Queen’s Medical Research Institute,
Edinburgh, UK
- Department of Plastic Surgery, NHS Lothian, Livingston, UK
| | - Zachary K. Bailey
- Department of Bioengineering, Imperial College London, South
Kensington Campus, UK
| | | | - Philip P. Vu
- Department of Biomedical Engineering, University of Michigan,
Ann Arbor, MI, USA
- Section of Plastic Surgery, University of Michigan, Ann Arbor,
MI, USA
| | - Cynthia A. Chestek
- Department of Biomedical Engineering, University of Michigan,
Ann Arbor, MI, USA
- Section of Plastic Surgery, University of Michigan, Ann Arbor,
MI, USA
- Department of Electrical Engineering and Computer Science,
University of Michigan, Ann Arbor, MI, USA
- Neuroscience Graduate Program, University of Michigan, Ann
Arbor, MI, USA
| | - Deanna H. Gates
- Robotics Institute, University of Michigan, Ann Arbor, MI,
USA
- Department of Biomedical Engineering, University of Michigan,
Ann Arbor, MI, USA
- School of Kinesiology, University of Michigan, Ann Arbor, MI,
USA
| | - Stephen W. P. Kemp
- Department of Biomedical Engineering, University of Michigan,
Ann Arbor, MI, USA
- Section of Plastic Surgery, University of Michigan, Ann Arbor,
MI, USA
| | - Paul S. Cederna
- Department of Biomedical Engineering, University of Michigan,
Ann Arbor, MI, USA
- Section of Plastic Surgery, University of Michigan, Ann Arbor,
MI, USA
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of
Technology, Sweden
- Operational Area 3, Sahlgrenska University Hospital, Mölndal,
Sweden
- Department of Orthopaedics, Institute of Clinical Sciences,
Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Oskar C. Aszmann
- Department of Plastic & Reconstructive Surgery, Medical
University of Vienna, Austria
- Clinical Laboratory for Bionic Extremity Reconstruction,
Medical University of Vienna, Austria
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16
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Tham JL, Sood A, Saffari TM, Khajuria A. The effect of targeted muscle reinnervation on post-amputation pain and functional outcomes: a systematic review and meta-analysis. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-02021-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Lee C, Vaskov AK, Gonzalez MA, Vu PP, Davis AJ, Cederna PS, Chestek CA, Gates DH. Use of regenerative peripheral nerve interfaces and intramuscular electrodes to improve prosthetic grasp selection: a case study. J Neural Eng 2022; 19:10.1088/1741-2552/ac9e1c. [PMID: 36317254 PMCID: PMC9942093 DOI: 10.1088/1741-2552/ac9e1c] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
Objective.Advanced myoelectric hands enable users to select from multiple functional grasps. Current methods for controlling these hands are unintuitive and require frequent recalibration. This case study assessed the performance of tasks involving grasp selection, object interaction, and dynamic postural changes using intramuscular electrodes with regenerative peripheral nerve interfaces (RPNIs) and residual muscles.Approach.One female with unilateral transradial amputation participated in a series of experiments to compare the performance of grasp selection controllers with RPNIs and intramuscular control signals with controllers using surface electrodes. These experiments included a virtual grasp-matching task with and without a concurrent cognitive task and physical tasks with a prosthesis including standardized functional assessments and a functional assessment where the individual made a cup of coffee ('Coffee Task') that required grasp transitions.Main results.In the virtual environment, the participant was able to select between four functional grasps with higher accuracy using the RPNI controller (92.5%) compared to surface controllers (81.9%). With the concurrent cognitive task, performance of the virtual task was more consistent with RPNI controllers (reduced accuracy by 1.1%) compared to with surface controllers (4.8%). When RPNI signals were excluded from the controller with intramuscular electromyography (i.e. residual muscles only), grasp selection accuracy decreased by up to 24%. The participant completed the Coffee Task with 11.7% longer completion time with the surface controller than with the RPNI controller. She also completed the Coffee Task with 11 fewer transition errors out of a maximum of 25 total errors when using the RPNI controller compared to surface controller.Significance.The use of RPNI signals in concert with residual muscles and intramuscular electrodes can improve grasp selection accuracy in both virtual and physical environments. This approach yielded consistent performance without recalibration needs while reducing cognitive load associated with pattern recognition for myoelectric control (clinical trial registration number NCT03260400).
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Affiliation(s)
- Christina Lee
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Alex K. Vaskov
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | | | - Philip P. Vu
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Alicia J. Davis
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Paul S. Cederna
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Cynthia A. Chestek
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Robotics Institute, University of Michigan, Ann Arbor, MI, USA
| | - Deanna H. Gates
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Robotics Institute, University of Michigan, Ann Arbor, MI, USA
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
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18
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Calotta NA, Hanwright PJ, Giladi A, Tuffaha SH. Vascularized, Denervated Muscle Targets for Treatment of Symptomatic Neuromas in the Upper Extremity: Description of Operative Technique. Tech Hand Up Extrem Surg 2022; 26:141-145. [PMID: 34817447 DOI: 10.1097/bth.0000000000000374] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Symptomatic neuromas of the upper extremity often cause persistent, debilitating pain that is resistant to medical management. Following upper extremity amputation, painful neuromas may disrupt rehabilitation efforts and pose a barrier to prosthetic use. Several surgical approaches have been attempted to treat neuromas, each of which suffers from limitations. We have developed a novel technique, the vascularized, denervated muscle target, that offers a compelling new option for primary prevention and secondary treatment of symptomatic neuromas of the upper extremity. Here, we provide a detailed description of our surgical technique as it is applied to neuromas of the upper extremity.
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Affiliation(s)
- Nicholas A Calotta
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | - Philip J Hanwright
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | - Aviram Giladi
- Curtis National Hand Center, Medstar Union Memorial Hospital, Baltimore, MD
| | - Sami H Tuffaha
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
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19
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Wu J, Zhang Y, Zhang X, Lin Z, Li G. Regenerative Peripheral Nerve Interfaces Effectively Prevent Neuroma Formation After Sciatic Nerve Transection in Rats. Front Mol Neurosci 2022; 15:938930. [PMID: 35875668 PMCID: PMC9301297 DOI: 10.3389/fnmol.2022.938930] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The disordered growth of nerve stumps after amputation leading to the formation of neuromas is an important cause of postoperative pain in amputees. This severely affects the patients' quality of life. Regenerative peripheral nerve interfaces (RPNIs) are an emerging method for neuroma prevention, but its postoperative nerve growth and pathological changes are yet to be studied. Methods The rat sciatic nerve transection model was used to study the effectiveness of RPNI in this experiment. The RPNI (experimental) group (n = 11) underwent RPNI implantation after sciatic nerve transection, while the control group (n = 11) only underwent sciatic nerve transection. Autotomy behavior, ultrasonography, and histopathology were observed for 2 months postoperatively. Results Compared to the control group, the incidence and size of the neuromas formed and the incidence and extent of autotomy were significantly reduced in the RPNI group. The axon density in the stump and degree of stump fibrosis were also significantly reduced in the RPNI group. Conclusion RPNI effectively prevented the formation of neuromas.
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Affiliation(s)
- Jiaqing Wu
- Department of Plastic Surgery, Peking University People's Hospital, Beijing, China
| | - Yajun Zhang
- Trauma Medicine Center, Peking University People's Hospital, Beijing, China
| | - Xiaoyuan Zhang
- Department of Plastic Surgery, Peking University People's Hospital, Beijing, China
| | - Zhiyu Lin
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Guangxue Li
- Department of Plastic Surgery, Peking University People's Hospital, Beijing, China
- *Correspondence: Guangxue Li
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20
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Scott BB, Winograd JM, Redmond RW. Surgical Approaches for Prevention of Neuroma at Time of Peripheral Nerve Injury. Front Surg 2022; 9:819608. [PMID: 35832494 PMCID: PMC9271873 DOI: 10.3389/fsurg.2022.819608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Abstract
Painful neuroma is a frequent sequela of peripheral nerve injury which can result in pain and decreased quality of life for the patient, often necessitating surgical intervention. End neuromas are benign neural tumors that commonly form after nerve transection, when axons from the proximal nerve stump regenerate in a disorganized manner in an attempt to recreate nerve continuity. Inflammation and collagen remodeling leads to a bulbous end neuroma which can become symptomatic and result in decreased quality of life. This review covers surgical prophylaxis of end neuroma formation at time of injury, rather than treatment of existing neuroma and prevention of recurrence. The current accepted methods to prevent end neuroma formation at time of injury include different mechanisms to inhibit the regenerative response or provide a conduit for organized regrowth, with mixed results. Approaches include proximal nerve stump capping, nerve implantation into bone, muscle and vein, various pharmacologic methods to inhibit axonal growth, and mechanisms to guide axonal growth after injury. This article reviews historical treatments that aimed to prevent end neuroma formation as well as current and experimental treatments, and seeks to provide a concise, comprehensive resource for current and future therapies aimed at preventing neuroma formation.
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Affiliation(s)
- Benjamin B. Scott
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Correspondence: Benjamin B. Scott
| | - Jonathan M. Winograd
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Robert W. Redmond
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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21
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Effective Treatment of Chronic Mastectomy Pain with Intercostal Sensory Neurectomy. Plast Reconstr Surg 2022; 149:876e-880e. [PMID: 35255058 DOI: 10.1097/prs.0000000000008975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Chronic postmastectomy pain affects up to 40 percent of patients and leads to diminished quality of life and increased risk of opioid dependence. The cause of this pain is incompletely understood; however, one hypothesis is that direct injury to cutaneous intercostal nerves at the time of mastectomy and/or reconstruction leads to chronic pain. As a result, proximal neurectomy of the involved sensory nerve(s) has been suggested to be effective for these patients. The purpose of this study was to determine whether chronic pain in postmastectomy patients can be diagnosed reliably in an office setting and pain reduced by intercostal sensory neurectomy. The authors performed a retrospective review of seven patients with a history of breast surgery and chronic pain who underwent intercostal neurectomy combined with muscle or dermal wrapping of the proximal end of the resected nerve. All patients were diagnosed by history and physical examination, and suspected nerves were further identified with local anesthetic nerve blocks. An average of 3.14 neurectomies were performed per patient (range, one to six). There was a significant reduction in visual analogue scale pain scores following surgery, from 9 preoperatively to 1 postoperatively (p = 0.02). Eighty-six percent of patients were pain-free or "considerably improved" at their latest follow-up appointment (average, 6.14 months). It is concluded that intercostal sensory nerve injury at the time of mastectomy and/or reconstruction can lead to chronic mastectomy pain, which can be easily diagnosed and effectively treated with intercostal neurectomy. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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22
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Berggren M, Głowacki ED, Simon DT, Stavrinidou E, Tybrandt K. In Vivo Organic Bioelectronics for Neuromodulation. Chem Rev 2022; 122:4826-4846. [PMID: 35050623 PMCID: PMC8874920 DOI: 10.1021/acs.chemrev.1c00390] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Indexed: 01/27/2023]
Abstract
The nervous system poses a grand challenge for integration with modern electronics and the subsequent advances in neurobiology, neuroprosthetics, and therapy which would become possible upon such integration. Due to its extreme complexity, multifaceted signaling pathways, and ∼1 kHz operating frequency, modern complementary metal oxide semiconductor (CMOS) based electronics appear to be the only technology platform at hand for such integration. However, conventional CMOS-based electronics rely exclusively on electronic signaling and therefore require an additional technology platform to translate electronic signals into the language of neurobiology. Organic electronics are just such a technology platform, capable of converting electronic addressing into a variety of signals matching the endogenous signaling of the nervous system while simultaneously possessing favorable material similarities with nervous tissue. In this review, we introduce a variety of organic material platforms and signaling modalities specifically designed for this role as "translator", focusing especially on recent implementation in in vivo neuromodulation. We hope that this review serves both as an informational resource and as an encouragement and challenge to the field.
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Affiliation(s)
- Magnus Berggren
- Laboratory
of Organic Electronics, Department of Science and Technology, Linköping University, 601 74 Norrköping, Sweden
| | - Eric D. Głowacki
- Laboratory
of Organic Electronics, Department of Science and Technology, Linköping University, 601 74 Norrköping, Sweden
- Bioelectronics
Materials and Devices, Central European
Institute of Technology, Brno University of Technology, Purkyňova 656/123, 612 00 Brno, Czech
Republic
| | - Daniel T. Simon
- Laboratory
of Organic Electronics, Department of Science and Technology, Linköping University, 601 74 Norrköping, Sweden
| | - Eleni Stavrinidou
- Laboratory
of Organic Electronics, Department of Science and Technology, Linköping University, 601 74 Norrköping, Sweden
| | - Klas Tybrandt
- Laboratory
of Organic Electronics, Department of Science and Technology, Linköping University, 601 74 Norrköping, Sweden
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23
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Approach to Diagnosis and Treatment of Dorsoradial Hand and Forearm Pain. J Hand Surg Am 2022; 47:172-179. [PMID: 34887137 DOI: 10.1016/j.jhsa.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/29/2021] [Accepted: 10/19/2021] [Indexed: 02/02/2023]
Abstract
Dorsoradial forearm and hand pain was historically considered difficult to treat surgically due to a particular susceptibility of the radial sensory nerve (RSN) to injury and/or compression. A nerve block, if it were done at all, was directed at the region of the anatomic snuff box to block the RSN in an effort to provide diagnostic information as to the pain etiology. Even for patients with pain relief following a diagnostic block, resecting the RSN often proved unsuccessful in fully relieving pain. The solution to successful treatment of this refractory pain problem was the realization that the RSN is not the sole source of sensory innervation to the dorsoradial wrist. In fact, in 75% of people the lateral antebrachial cutaneous nerve (LABCN) dermatome overlaps the RSN with other nerves, such as the dorsal ulnar cutaneous nerve and even the posterior antebrachial cutaneous nerves, occasionally providing sensory innervation to the same area. With this more refined understanding of the cutaneous neuroanatomy of the wrist, the diagnostic nerve block algorithm was expanded to include selective blockage of more than just the RSN. In contemporary practice, identification of the exact nerves responsible for pain signal generation informs surgical decision-making for palliative neurolysis or neurectomy. This approach offers a systematic and repeatable method to inform the diagnosis and treatment of dorsoradial forearm and wrist pain.
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24
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Regenerative Peripheral Nerve Interfaces for Advanced Prosthetic Control and Mitigation of Postamputation Pain. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Ganesh Kumar N, Kung TA, Cederna PS. Regenerative Peripheral Nerve Interfaces for Advanced Control of Upper Extremity Prosthetic Devices. Hand Clin 2021; 37:425-433. [PMID: 34253315 DOI: 10.1016/j.hcl.2021.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The quest to find the ideal prosthetic device interface that enables intuitive control has motivated several recent innovations. Although current prosthetic device control strategies have advanced the field of neuroprosthetic control, they are limited in their ability to generate reliable, stable, and specific signals to replicate the complex movements of the upper extremity. The regenerative peripheral nerve interface (RPNI) is a promising solution to enhance prosthetic device control. This article describes the development of RPNIs and summarizes its successful use in the control of advanced prosthetic devices in patients with upper extremity amputations.
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Affiliation(s)
- Nishant Ganesh Kumar
- Section of Plastic Surgery, Department of Surgery, University of Michigan, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0340, USA
| | - Theodore A Kung
- Section of Plastic Surgery, Department of Surgery, University of Michigan, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0340, USA
| | - Paul S Cederna
- Section of Plastic Surgery, Department of Surgery, University of Michigan, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0340, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
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26
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Hoyt BW, Potter BK, Souza JM. Nerve Interface Strategies for Neuroma Management and Prevention: A Conceptual Approach Guided by Institutional Experience. Hand Clin 2021; 37:373-382. [PMID: 34253310 DOI: 10.1016/j.hcl.2021.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In this article, the authors propose a strategy to manage and prevent symptomatic neuromas using a combination of nerve interface approaches. By using a reconstructive paradigm, these procedures provide the components integral to organized nerve regeneration, conferring both improvements in pain and potential for myoelectric control of prostheses in the future. Given the lack of evidence at this point indicating the advantage of any single nerve interface procedure, the authors propose a management approach that maximizes physiologic restoration while limiting morbidity where possible.
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Affiliation(s)
- Benjamin W Hoyt
- USU-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Uniformed Services University, 8901 Wisconsin Avenue, Bethesda, MD 20814, USA
| | - Benjamin K Potter
- USU-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Uniformed Services University, 8901 Wisconsin Avenue, Bethesda, MD 20814, USA
| | - Jason M Souza
- Peripheral Nerve Program, USU-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Uniformed Services University, 8901 Wisconsin Avenue, Bethesda, MD 20814, USA.
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27
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Abstract
Chronic pain is a significant health care problem. Many patients' pain can be linked to a neuropathic origin, diagnosed with a thorough history and physical examination, and confirmed with a diagnostic nerve block. There are new procedures designed to address neuropathic pain from symptomatic neuromas by providing physiologic targets for regenerating axons following neurectomy. Dermal wrapping of the end of a sensory nerve following transection, a technique called dermatosensory peripheral nerve interface, may provide an optimal environment to prevent neuroma pain and reduce chronic neuropathic pain.
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28
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Karczewski AM, Dingle AM, Poore SO. The Need to Work Arm in Arm: Calling for Collaboration in Delivering Neuroprosthetic Limb Replacements. Front Neurorobot 2021; 15:711028. [PMID: 34366820 PMCID: PMC8334559 DOI: 10.3389/fnbot.2021.711028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/22/2021] [Indexed: 11/21/2022] Open
Abstract
Over the last few decades there has been a push to enhance the use of advanced prosthetics within the fields of biomedical engineering, neuroscience, and surgery. Through the development of peripheral neural interfaces and invasive electrodes, an individual's own nervous system can be used to control a prosthesis. With novel improvements in neural recording and signal decoding, this intimate communication has paved the way for bidirectional and intuitive control of prostheses. While various collaborations between engineers and surgeons have led to considerable success with motor control and pain management, it has been significantly more challenging to restore sensation. Many of the existing peripheral neural interfaces have demonstrated success in one of these modalities; however, none are currently able to fully restore limb function. Though this is in part due to the complexity of the human somatosensory system and stability of bioelectronics, the fragmentary and as-yet uncoordinated nature of the neuroprosthetic industry further complicates this advancement. In this review, we provide a comprehensive overview of the current field of neuroprosthetics and explore potential strategies to address its unique challenges. These include exploration of electrodes, surgical techniques, control methods, and prosthetic technology. Additionally, we propose a new approach to optimizing prosthetic limb function and facilitating clinical application by capitalizing on available resources. It is incumbent upon academia and industry to encourage collaboration and utilization of different peripheral neural interfaces in combination with each other to create versatile limbs that not only improve function but quality of life. Despite the rapidly evolving technology, if the field continues to work in divided "silos," we will delay achieving the critical, valuable outcome: creating a prosthetic limb that is right for the patient and positively affects their life.
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Affiliation(s)
| | - Aaron M. Dingle
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin–Madison, Madison, WI, United States
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29
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Vu PP, Vaskov AK, Irwin ZT, Henning PT, Lueders DR, Laidlaw AT, Davis AJ, Nu CS, Gates DH, Gillespie RB, Kemp SWP, Kung TA, Chestek CA, Cederna PS. A regenerative peripheral nerve interface allows real-time control of an artificial hand in upper limb amputees. Sci Transl Med 2021; 12:12/533/eaay2857. [PMID: 32132217 DOI: 10.1126/scitranslmed.aay2857] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/28/2019] [Accepted: 12/27/2019] [Indexed: 11/02/2022]
Abstract
Peripheral nerves provide a promising source of motor control signals for neuroprosthetic devices. Unfortunately, the clinical utility of current peripheral nerve interfaces is limited by signal amplitude and stability. Here, we showed that the regenerative peripheral nerve interface (RPNI) serves as a biologically stable bioamplifier of efferent motor action potentials with long-term stability in upper limb amputees. Ultrasound assessments of RPNIs revealed prominent contractions during phantom finger flexion, confirming functional reinnervation of the RPNIs in two patients. The RPNIs in two additional patients produced electromyography signals with large signal-to-noise ratios. Using these RPNI signals, subjects successfully controlled a hand prosthesis in real-time up to 300 days without control algorithm recalibration. RPNIs show potential in enhancing prosthesis control for people with upper limb loss.
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Affiliation(s)
- Philip P Vu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alex K Vaskov
- Robotics Institute, University of Michigan, Ann Arbor, MI 48109, USA
| | - Zachary T Irwin
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Phillip T Henning
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48109, USA
| | - Daniel R Lueders
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ann T Laidlaw
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alicia J Davis
- University of Michigan Hospital Orthotics and Prosthetics Center, Ann Arbor, MI 48109, USA
| | - Chrono S Nu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Deanna H Gates
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA.,Robotics Institute, University of Michigan, Ann Arbor, MI 48109, USA.,School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - R Brent Gillespie
- Robotics Institute, University of Michigan, Ann Arbor, MI 48109, USA.,Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stephen W P Kemp
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Theodore A Kung
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Cynthia A Chestek
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA. .,Robotics Institute, University of Michigan, Ann Arbor, MI 48109, USA.,Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI 48109, USA.,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI 48109, USA
| | - Paul S Cederna
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA. .,Section of Plastic Surgery, University of Michigan, Ann Arbor, MI 48109, USA
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30
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Hoyt BW, Gibson JA, Potter BK, Souza JM. Practice Patterns and Pain Outcomes for Targeted Muscle Reinnervation: An Informed Approach to Targeted Muscle Reinnervation Use in the Acute Amputation Setting. J Bone Joint Surg Am 2021; 103:681-687. [PMID: 33849050 DOI: 10.2106/jbjs.20.01005] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) procedures have been shown to improve patient-reported outcomes for the treatment of symptomatic neuromas after amputation; however, the specific indications and comparative outcomes of each are unclear. The primary research questions were what complement of nerves most frequently requires secondary pain intervention after conventional amputation, whether this information can guide the focused application of TMR and RPNI to the primary amputation setting, and how the outcomes compare in both settings. METHODS We performed a retrospective review of records for patients who had undergone lower-extremity TMR and/or RPNI at our institution. Eighty-seven procedures were performed: 59 for the secondary treatment of symptomatic neuroma pain after amputation and 28 for primary prophylaxis during amputation. We reviewed records for the amputation level, TMR and/or RPNI timing, pain scores, patient-reported resolution of nerve-related symptoms, and complications or revisions. We evaluated the relationship between the amputation level and the frequency with which each transected nerve required neurologic intervention for pain symptoms. RESULTS The mean pain score decreased after delayed TMR or RPNI procedures from 4.3 points to 1.7 points (p < 0.001), and the mean final pain score (and standard deviation) was 1.0 ± 1.9 points at the time of follow-up for acute procedures. Symptom resolution was achieved in 92% of patients. The sciatic nerve most commonly required intervention for symptomatic neuroma above the knee, and the tibial nerve and common or superficial peroneal nerve were most problematic following transtibial amputation. None of our patients required a revision pain treatment procedure after primary TMR targeting these commonly symptomatic nerves. Failure to address the tibial nerve during a delayed procedure was associated with an increased risk of unsuccessful TMR, resulting in a revision surgical procedure (odds ratio, 26 [95% confidence interval, 1.8 to 368]; p = 0.02). CONCLUSIONS There is a consistent pattern of symptomatic nerves that require secondary surgical intervention for the management of pain after amputation. TMR and RPNI were translated to the primary amputation setting by using this predictable pattern to devise a surgical strategy that prevents symptomatic neuroma pain. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Benjamin W Hoyt
- USU-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
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31
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Targeted Peripheral Nerve Interface: Case Report with Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3532. [PMID: 33854867 PMCID: PMC8032355 DOI: 10.1097/gox.0000000000003532] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/17/2021] [Indexed: 11/25/2022]
Abstract
Nerve transection injuries can result in painful neuromas that adversely affect patient recovery. This is especially significant following amputation surgeries in the setting of prosthetic wear and function. Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interface (RPNI) are 2 modern surgical techniques that provide neuromuscular targets for these transected nerve endings to reinnervate. These strategies have been previously shown to reduce phantom limb pain, residual limb pain, and neuroma-related pain.1,2,7,11 Two recent articles described technical adaptations of combining targeted muscle reinnervation and RPNI to create a hybrid procedure.3,12 In this article, we propose a different modification of targeted muscle reinnervation and RPNI, where the transected nerve stump is coapted to a recipient unit consisting of an intact distal nerve branch with its associated muscle graft. We called this recipient unit a targeted peripheral nerve interface because it contains a distal nerve branch for nerve coaptation and can guide axonal regeneration from the donor nerve to its target muscle graft. We theorize that targeted peripheral nerve interface may lead to more even distribution of regenerating axons with potentially less pain and stronger signals for prosthetic control when compared with standard RPNI.
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32
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Khodabukus A. Tissue-Engineered Skeletal Muscle Models to Study Muscle Function, Plasticity, and Disease. Front Physiol 2021; 12:619710. [PMID: 33716768 PMCID: PMC7952620 DOI: 10.3389/fphys.2021.619710] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/25/2021] [Indexed: 12/20/2022] Open
Abstract
Skeletal muscle possesses remarkable plasticity that permits functional adaptations to a wide range of signals such as motor input, exercise, and disease. Small animal models have been pivotal in elucidating the molecular mechanisms regulating skeletal muscle adaptation and plasticity. However, these small animal models fail to accurately model human muscle disease resulting in poor clinical success of therapies. Here, we review the potential of in vitro three-dimensional tissue-engineered skeletal muscle models to study muscle function, plasticity, and disease. First, we discuss the generation and function of in vitro skeletal muscle models. We then discuss the genetic, neural, and hormonal factors regulating skeletal muscle fiber-type in vivo and the ability of current in vitro models to study muscle fiber-type regulation. We also evaluate the potential of these systems to be utilized in a patient-specific manner to accurately model and gain novel insights into diseases such as Duchenne muscular dystrophy (DMD) and volumetric muscle loss. We conclude with a discussion on future developments required for tissue-engineered skeletal muscle models to become more mature, biomimetic, and widely utilized for studying muscle physiology, disease, and clinical use.
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Affiliation(s)
- Alastair Khodabukus
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
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33
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Millevolte AXT, Dingle AM, Ness JP, Novello J, Zeng W, Lu Y, Minor RL, Nemke B, Markel MD, Suminski AJ, Williams JC, Poore SO. Improving the Selectivity of an Osseointegrated Neural Interface: Proof of Concept For Housing Sieve Electrode Arrays in the Medullary Canal of Long Bones. Front Neurosci 2021; 15:613844. [PMID: 33790731 PMCID: PMC8006940 DOI: 10.3389/fnins.2021.613844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 02/16/2021] [Indexed: 01/15/2023] Open
Abstract
Sieve electrodes stand poised to deliver the selectivity required for driving advanced prosthetics but are considered inherently invasive and lack the stability required for a chronic solution. This proof of concept experiment investigates the potential for the housing and engagement of a sieve electrode within the medullary canal as part of an osseointegrated neural interface (ONI) for greater selectivity toward improving prosthetic control. The working hypotheses are that (A) the addition of a sieve interface to a cuff electrode housed within the medullary canal of the femur as part of an ONI would be capable of measuring efferent and afferent compound nerve action potentials (CNAPs) through a greater number of channels; (B) that signaling improves over time; and (C) that stimulation at this interface generates measurable cortical somatosensory evoked potentials through a greater number of channels. The modified ONI was tested in a rabbit (n = 1) amputation model over 12 weeks, comparing the sieve component to the cuff, and subsequently compared to historical data. Efferent CNAPs were successfully recorded from the sieve demonstrating physiological improvements in CNAPs between weeks 3 and 5, and somatosensory cortical responses recorded at 12 weeks postoperatively. This demonstrates that sieve electrodes can be housed and function within the medullary canal, demonstrated by improved nerve engagement and distinct cortical sensory feedback. This data presents the conceptual framework for housing more sophisticated sieve electrodes in bone as part of an ONI for improving selectivity with percutaneous connectivity toward improved prosthetic control.
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Affiliation(s)
- Augusto X T Millevolte
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States.,Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States
| | - Aaron M Dingle
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States
| | - Jared P Ness
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States
| | - Joseph Novello
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States
| | - Weifeng Zeng
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States
| | - Yan Lu
- Department of Medical Sciences, University of Wisconsin - Madison, Madison, WI, United States
| | - Rashea L Minor
- Department of Medical Sciences, University of Wisconsin - Madison, Madison, WI, United States
| | - Brett Nemke
- Department of Medical Sciences, University of Wisconsin - Madison, Madison, WI, United States
| | - Mark D Markel
- Department of Medical Sciences, University of Wisconsin - Madison, Madison, WI, United States
| | - Aaron J Suminski
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States.,Department of Medical Sciences, University of Wisconsin - Madison, Madison, WI, United States.,Department of Neurological Surgery, University of Wisconsin - Madison, Madison, WI, United States
| | - Justin C Williams
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States.,Department of Neurological Surgery, University of Wisconsin - Madison, Madison, WI, United States
| | - Samuel O Poore
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States.,Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States
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Abstract
When nerves are damaged by trauma or disease, they are still capable of firing off electrical command signals that originate from the brain. Furthermore, those damaged nerves have an innate ability to partially regenerate, so they can heal from trauma and even reinnervate new muscle targets. For an amputee who has his/her damaged nerves surgically reconstructed, the electrical signals that are generated by the reinnervated muscle tissue can be sensed and interpreted with bioelectronics to control assistive devices or robotic prostheses. No two amputees will have identical physiologies because there are many surgical options for reconstructing residual limbs, which may in turn impact how well someone can interface with a robotic prosthesis later on. In this review, we aim to investigate what the literature has to say about different pathways for peripheral nerve regeneration and how each pathway can impact the neuromuscular tissue’s final electrophysiology. This information is important because it can guide us in planning the development of future bioelectronic devices, such as prosthetic limbs or neurostimulators. Future devices will primarily have to interface with tissue that has undergone some natural regeneration process, and so we have explored and reported here what is known about the bioelectrical features of neuromuscular tissue regeneration.
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Llerena Zambrano B, Renz AF, Ruff T, Lienemann S, Tybrandt K, Vörös J, Lee J. Soft Electronics Based on Stretchable and Conductive Nanocomposites for Biomedical Applications. Adv Healthc Mater 2021; 10:e2001397. [PMID: 33205564 DOI: 10.1002/adhm.202001397] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/08/2020] [Indexed: 12/15/2022]
Abstract
Research on the field of implantable electronic devices that can be directly applied in the body with various functionalities is increasingly intensifying due to its great potential for various therapeutic applications. While conventional implantable electronics generally include rigid and hard conductive materials, their surrounding biological objects are soft and dynamic. The mechanical mismatch between implanted devices and biological environments induces damages in the body especially for long-term applications. Stretchable electronics with outstanding mechanical compliance with biological objects effectively improve such limitations of existing rigid implantable electronics. In this article, the recent progress of implantable soft electronics based on various conductive nanocomposites is systematically described. In particular, representative fabrication approaches of conductive and stretchable nanocomposites for implantable soft electronics and various in vivo applications of implantable soft electronics are focused on. To conclude, challenges and perspectives of current implantable soft electronics that should be considered for further advances are discussed.
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Affiliation(s)
- Byron Llerena Zambrano
- Laboratory of Biosensors and Bioelectronics ETH Zurich Gloriastrasse 35 Zurich 8092 Switzerland
| | - Aline F. Renz
- Laboratory of Biosensors and Bioelectronics ETH Zurich Gloriastrasse 35 Zurich 8092 Switzerland
| | - Tobias Ruff
- Laboratory of Biosensors and Bioelectronics ETH Zurich Gloriastrasse 35 Zurich 8092 Switzerland
| | - Samuel Lienemann
- Laboratory of Organic Electronics Department of Science and Technology Linköping University Norrköping 601 74 Sweden
| | - Klas Tybrandt
- Laboratory of Organic Electronics Department of Science and Technology Linköping University Norrköping 601 74 Sweden
| | - János Vörös
- Laboratory of Biosensors and Bioelectronics ETH Zurich Gloriastrasse 35 Zurich 8092 Switzerland
| | - Jaehong Lee
- Department of Robotics Engineering Daegu Gyeongbuk Institute of Science and Technology (DGIST) 333 Techno jungan‐dareo Daegu 42988 South Korea
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Srinivasan SS, Carty MJ, Calvaresi PW, Clites TR, Maimon BE, Taylor CR, Zorzos AN, Herr H. On prosthetic control: A regenerative agonist-antagonist myoneural interface. Sci Robot 2021; 2:2/6/eaan2971. [PMID: 33157872 DOI: 10.1126/scirobotics.aan2971] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/10/2017] [Indexed: 01/25/2023]
Abstract
Prosthetic limb control is fundamentally constrained by the current amputation procedure. Since the U.S. Civil War, the external prosthesis has benefited from a pronounced level of innovation, but amputation technique has not significantly changed. During a standard amputation, nerves are transected without the reintroduction of proper neural targets, causing painful neuromas and rendering efferent recordings infeasible. Furthermore, the physiological agonist-antagonist muscle relationships are severed, precluding the generation of musculotendinous proprioception, an afferent feedback modality critical for joint stability, trajectory planning, and fine motor control. We establish an agonist-antagonist myoneural interface (AMI), a unique surgical paradigm for amputation. Regenerated free muscle grafts innervated with transected nerves are linked in agonist-antagonist relationships, emulating the dynamic interactions found within an intact limb. Using biomechanical, electrophysiological, and histological evaluations, we demonstrate a viable architecture for bidirectional signaling with transected motor nerves. Upon neural activation, the agonist muscle contracts, generating electromyographic signal. This contraction in the agonist creates a stretch in the mechanically linked antagonist muscle, producing afferent feedback, which is transmitted through its motor nerve. Histological results demonstrate regeneration and the presence of the spindle fibers responsible for afferent signal generation. These results suggest that the AMI will not only produce robust signals for the efferent control of an external prosthesis but also provide an amputee's central nervous system with critical musculotendinous proprioception, offering the potential for an enhanced prosthetic controllability and sensation.
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Affiliation(s)
- S S Srinivasan
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - M J Carty
- Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - P W Calvaresi
- Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - T R Clites
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - B E Maimon
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - C R Taylor
- Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Media Arts and Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - A N Zorzos
- Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - H Herr
- Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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Neuromuscular reinnervation efficacy using a YFP model. J Plast Reconstr Aesthet Surg 2020; 74:569-580. [PMID: 33218962 DOI: 10.1016/j.bjps.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 08/02/2020] [Accepted: 10/10/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The gold standard reconstruction for facial reanimation is the functional muscle transfer. The reinnervation of a muscle is never complete, and clinical results are variable with 20% not achieving a satisfactory outcome. We hypothesise that this may be due to a mismatch between the characteristics of the donor nerve and transferred muscle. METHOD 81 YFP-16 and 14 YFP-H mice were studied in three intervention groups over three time periods. Two parameters were investigated: the number and surface area of reinnervated neuromuscular junctions and regenerating axons. An assessment was made of motor unit proportions. RESULTS All cases of nerve repair and nerve graft, the neuromuscular junctions (NMJ) were completely reinnervated by regenerating axons. The number and calibre of the regenerating axons were significantly different from controls for both intervention groups. The motor units were smaller in both intervention groups. DISCUSSION Reinnervation occurs after nerve repair or graft; however, the arbour was reinnervated by large numbers of much smaller axons. These axons showed some evidence of remodelling in the repair group, but not in the graft group. Neither group achieved the parameters of the control group. There were persistent qualitative changes to the morphology of both axons and junctions. Imaging documented both synkinesis and alterations that resemble those seen in ageing. CONCLUSION Overall, the efficacy of reinnervation is very high with all NMJ reoccupied by regenerating axons. The way small axons are remodelled is different in the nerve repairs compared with the nerve grafts.
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Milici S, Gherardini M, Clemente F, Masiero F, Sassu P, Cipriani C. The Myokinetic Control Interface: How Many Magnets Can be Implanted in an Amputated Forearm? Evidence From a Simulated Environment. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2451-2458. [PMID: 32956064 DOI: 10.1109/tnsre.2020.3024960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We recently introduced the concept of a new human-machine interface (the myokinetic control interface) to control hand prostheses. The interface tracks muscle contractions via permanent magnets implanted in the muscles and magnetic field sensors hosted in the prosthetic socket. Previously we showed the feasibility of localizing several magnets in non-realistic workspaces. Here, aided by a 3D CAD model of the forearm, we computed the localization accuracy simulated for three different below-elbow amputation levels, following general guidelines identified in early work. To this aim we first identified the number of magnets that could fit and be tracked in a proximal (T1), middle (T2) and distal (T3) representative amputation, starting from 18, 20 and 23 eligible muscles, respectively. Then we ran a localization algorithm to estimate the poses of the magnets based on the sensor readings. A sensor selection strategy (from an initial grid of 840 sensors) was also implemented to optimize the computational cost of the localization process. Results showed that the localizer was able to accurately track up to 11 (T1), 13 (T2) and 19 (T3) magnetic markers (MMs) with an array of 154, 205 and 260 sensors, respectively. Localization errors lower than 7% the trajectory travelled by the magnets during muscle contraction were always achieved. This work not only answers the question: "how many magnets could be implanted in a forearm and successfully tracked with a the myokinetic control approach?", but also provides interesting insights for a wide range of bioengineering applications exploiting magnetic tracking.
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TMRpni: Combining Two Peripheral Nerve Management Techniques. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3132. [PMID: 33173670 PMCID: PMC7647640 DOI: 10.1097/gox.0000000000003132] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/31/2020] [Indexed: 11/26/2022]
Abstract
Amputee patients suffer high rates of chronic neuropathic pain, residual limb dysfunction, and disability. Recently, targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) are 2 techniques that have been advocated for such patients, given their ability to maximize intuitive prosthetic function while also minimizing neuropathic pain, such as residual and phantom limb pain. However, there remains room to further improve outcomes for our residual limb patients and patients suffering from symptomatic end neuromas. "TMRpni" is a nerve management technique that leverages beneficial elements described for both TMR and RPNI. TMRpni involves coaptation of a sensory or mixed sensory/motor nerve to a nearby motor nerve branch (ie, a nerve transfer), as performed in traditional TMR surgeries. Additionally, the typically mismatched nerve coaptation is wrapped with an autologous free muscle graft that is akin to an RPNI. The authors herein describe the "TMRpni" technique and illustrate a case where this technique was employed.
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40
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Novel Approaches to Reduce Symptomatic Neuroma Pain After Limb Amputation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00276-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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41
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Vu PP, Chestek CA, Nason SR, Kung TA, Kemp SW, Cederna PS. The future of upper extremity rehabilitation robotics: research and practice. Muscle Nerve 2020; 61:708-718. [PMID: 32413247 PMCID: PMC7868083 DOI: 10.1002/mus.26860] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 01/14/2023]
Abstract
The loss of upper limb motor function can have a devastating effect on people's lives. To restore upper limb control and functionality, researchers and clinicians have developed interfaces to interact directly with the human body's motor system. In this invited review, we aim to provide details on the peripheral nerve interfaces and brain-machine interfaces that have been developed in the past 30 years for upper extremity control, and we highlight the challenges that still remain to transition the technology into the clinical market. The findings show that peripheral nerve interfaces and brain-machine interfaces have many similar characteristics that enable them to be concurrently developed. Decoding neural information from both interfaces may lead to novel physiological models that may one day fully restore upper limb motor function for a growing patient population.
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Affiliation(s)
- Philip P. Vu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Cynthia A. Chestek
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
- Robotics Institute, University of Michigan, Ann Arbor, Michigan
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, Michigan
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, Michigan
| | - Samuel R. Nason
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Theodore A. Kung
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Stephen W.P. Kemp
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Paul S. Cederna
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
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42
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Vascularized, Denervated Muscle Targets: A Novel Approach to Treat and Prevent Symptomatic Neuromas. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2779. [PMID: 32440442 PMCID: PMC7209893 DOI: 10.1097/gox.0000000000002779] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/24/2020] [Indexed: 01/26/2023]
Abstract
There are many surgical approaches described to treat and prevent symptomatic neuromas, each of which has significant limitations. Here we describe the rationale and technical approach for a novel method that carries the promise of addressing some of these limitations.
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43
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Rochford AE, Carnicer-Lombarte A, Curto VF, Malliaras GG, Barone DG. When Bio Meets Technology: Biohybrid Neural Interfaces. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e1903182. [PMID: 31517403 DOI: 10.1002/adma.201903182] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/06/2019] [Indexed: 06/10/2023]
Abstract
The development of electronics capable of interfacing with the nervous system is a rapidly advancing field with applications in basic science and clinical translation. Devices containing arrays of electrodes can be used in the study of cells grown in culture or can be implanted into damaged or dysfunctional tissue to restore normal function. While devices are typically designed and used exclusively for one of these two purposes, there have been increasing efforts in developing implantable electrode arrays capable of housing cultured cells, referred to as biohybrid implants. Once implanted, the cells within these implants integrate into the tissue, serving as a mediator of the electrode-tissue interface. This biological component offers unique advantages to these implant designs, providing better tissue integration and potentially long-term stability. Herein, an overview of current research into biohybrid devices, as well as the historical background that led to their development are provided, based on the host anatomical location for which they are designed (CNS, PNS, or special senses). Finally, a summary of the key challenges of this technology and potential future research directions are presented.
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Affiliation(s)
- Amy E Rochford
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, CB3 0FA, UK
| | | | - Vincenzo F Curto
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, CB3 0FA, UK
| | - George G Malliaras
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, CB3 0FA, UK
| | - Damiano G Barone
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, CB3 0FA, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
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44
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Targeted Muscle Reinnervation Combined with a Vascularized Pedicled Regenerative Peripheral Nerve Interface. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2689. [PMID: 32537346 PMCID: PMC7253250 DOI: 10.1097/gox.0000000000002689] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/15/2020] [Indexed: 11/25/2022]
Abstract
Symptomatic neuromas and pain caused by nerve transection injuries can adversely impact a patient’s recovery, while also contributing to increased dependence on opioid and other pharmacotherapy. These sources of pain are magnified following amputation surgeries, inhibiting optimal prosthetic wear and function. Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interfaces (RPNI) represent modern advances in addressing amputated peripheral nerves. These techniques offer solutions by essentially providing neuromuscular targets for transected peripheral nerves “to grow into and reinnervate.” Recent described benefits of these techniques include reports on pain reduction or ablation (eg, phantom limb pain, residual limb pain, and/or neuroma pain).1–6 We describe a technical adaptation combining TMR with a “pedicled vascularized RPNI (vRPNI).” The TMR with the vRPNI surgical technique described offers the advantage of having a distal target nerve and a target muscle possessing deinnervated motor end plates which may potentially enhance nerve regeneration and muscle reinnervation, while also decreasing amputated nerve-related pain.
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45
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Dellon AL, Aszmann OC. In musculus, veritas? Nerve "in muscle" versus targeted muscle reinnervation versus regenerative peripheral nerve interface: Historical review. Microsurgery 2020; 40:516-522. [PMID: 32181914 DOI: 10.1002/micr.30575] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/21/2020] [Indexed: 11/08/2022]
Affiliation(s)
| | - Oskar C Aszmann
- Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
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46
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Aman M, Bergmeister KD, Festin C, Sporer ME, Russold MF, Gstoettner C, Podesser BK, Gail A, Farina D, Cederna P, Aszmann OC. Experimental Testing of Bionic Peripheral Nerve and Muscle Interfaces: Animal Model Considerations. Front Neurosci 2020; 13:1442. [PMID: 32116485 PMCID: PMC7025572 DOI: 10.3389/fnins.2019.01442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/23/2019] [Indexed: 12/05/2022] Open
Abstract
Introduction: Man-machine interfacing remains the main challenge for accurate and reliable control of bionic prostheses. Implantable electrodes in nerves and muscles may overcome some of the limitations by significantly increasing the interface's reliability and bandwidth. Before human application, experimental preclinical testing is essential to assess chronic in-vivo biocompatibility and functionality. Here, we analyze available animal models, their costs and ethical challenges in special regards to simulating a potentially life-long application in a short period of time and in non-biped animals. Methods: We performed a literature analysis following the PRISMA guidelines including all animal models used to record neural or muscular activity via implantable electrodes, evaluating animal models, group size, duration, origin of publication as well as type of interface. Furthermore, behavioral, ethical, and economic considerations of these models were analyzed. Additionally, we discuss experience and surgical approaches with rat, sheep, and primate models and an approach for international standardized testing. Results: Overall, 343 studies matched the search terms, dominantly originating from the US (55%) and Europe (34%), using mainly small animal models (rat: 40%). Electrode placement was dominantly neural (77%) compared to muscular (23%). Large animal models had a mean duration of 135 ± 87.2 days, with a mean of 5.3 ± 3.4 animals per trial. Small animal models had a mean duration of 85 ± 11.2 days, with a mean of 12.4 ± 1.7 animals. Discussion: Only 37% animal models were by definition chronic tests (>3 months) and thus potentially provide information on long-term performance. Costs for large animals were up to 45 times higher than small animals. However, costs are relatively small compared to complication costs in human long-term applications. Overall, we believe a combination of small animals for preliminary primary electrode testing and large animals to investigate long-term biocompatibility, impedance, and tissue regeneration parameters provides sufficient data to ensure long-term human applications.
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Affiliation(s)
- Martin Aman
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Konstantin D Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Christopher Festin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthias E Sporer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | | | - Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Bruno K Podesser
- Division of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Alexander Gail
- Cognitive Neuroscience Lab, German Primate Center, Göttingen, Germany
| | - Dario Farina
- Department of Bioengineering, Imperial College, London, United Kingdom
| | - Paul Cederna
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
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Abstract
Osseointegration is a surgical approach that permitted the direct attachment of an external prosthesis to the skeleton in some select patients with amputation, who had failed to tolerate conventional sockets, thereby obviating related issues such as discomfort, skin breakdown, and poor fit. In this specific population, osseointegration offers the potential for enhanced biomechanical advantage and rehabilitative potential. Multiple percutaneous implant systems exist for clinical use internationally, each attempting to create a stable bone-implant interface while avoiding complications such as infection and loosening. Prospective clinical trials are now underway in the United States. This article will review the history and biology of osseointegration, indications and contraindications for use of currently available implant systems, and reported outcomes. Future directions of orthopaedic osseointegration technology, including electronic systems capable of biomimetic bidirectional volitional motor control of, and sensory/proprioceptive feedback from, external prosthetic devices, will also be discussed.
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48
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Dingle AM, Ness JP, Novello J, Israel JS, Sanchez R, Millevolte AXT, Brodnick S, Krugner-Higby L, Nemke B, Lu Y, Suminski AJ, Markel MD, Williams JC, Poore SO. Methodology for creating a chronic osseointegrated neural interface for prosthetic control in rabbits. J Neurosci Methods 2019; 331:108504. [PMID: 31711884 DOI: 10.1016/j.jneumeth.2019.108504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Chronic stability and high degrees of selectivity are both essential but somewhat juxtaposed components for creating an implantable bi-directional PNI capable of controlling of a prosthetic limb. While the more invasive implantable electrode arrays provide greater specificity, they are less stable over time due to compliance mismatch with the dynamic soft tissue environment in which the interface is created. NEW METHOD This paper takes the surgical approach of transposing nerves into bone to create neural interface within the medullary canal of long bones, an osseointegrated neural interface, to provide greater stability for implantable electrodes. In this context, we describe the surgical model for transfemoral amputation with transposition of the sciatic nerve into the medullary canal in rabbits. We investigate the capacity to create a neural interface within the medullary canal histolomorphologically. In a separate proof of concept experiment, we quantify the chronic physiological capacity of transposed nerves to conduct compound nerve action potentials evoked via an Osseointegrated Neural Interface. COMPARISON WITH EXISTING METHOD(S) The rabbit serves as an important animal model for both amputation neuroma and osseointegration research, but is underutilized for the exploration neural interfacing in an amputation setting. RESULTS Our findings demonstrate that transposed nerves remain stable over 12 weeks. Creating a neural interface within the medullary canal is possible and does not impede nerve regeneration or physiological capacity. CONCLUSIONS This article represents the first evidence that an Osseointegrated Neural Interface can be surgically created, capable of chronic stimulation/recording from amputated nerves required for future prosthetic control.
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Affiliation(s)
- Aaron M Dingle
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States
| | - Jared P Ness
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States
| | - Joseph Novello
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States
| | - Jacqueline S Israel
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States
| | - Ruston Sanchez
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States
| | - Augusto X T Millevolte
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States
| | - Sarah Brodnick
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States
| | - Lisa Krugner-Higby
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin - Madison, Madison, WI, United States
| | - Brett Nemke
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin - Madison, Madison, WI, United States
| | - Yan Lu
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin - Madison, Madison, WI, United States
| | - Aaron J Suminski
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States; Department of Neurological Surgery, University of Wisconsin - Madison, Madison, WI, United States
| | - Mark D Markel
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin - Madison, Madison, WI, United States
| | - Justin C Williams
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States
| | - Samuel O Poore
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States; Department of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, United States.
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49
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Wang J, Khodabukus A, Rao L, Vandusen K, Abutaleb N, Bursac N. Engineered skeletal muscles for disease modeling and drug discovery. Biomaterials 2019; 221:119416. [PMID: 31419653 DOI: 10.1016/j.biomaterials.2019.119416] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 01/04/2023]
Abstract
Skeletal muscle is the largest organ of human body with several important roles in everyday movement and metabolic homeostasis. The limited ability of small animal models of muscle disease to accurately predict drug efficacy and toxicity in humans has prompted the development in vitro models of human skeletal muscle that fatefully recapitulate cell and tissue level functions and drug responses. We first review methods for development of three-dimensional engineered muscle tissues and organ-on-a-chip microphysiological systems and discuss their potential utility in drug discovery research and development of new regenerative therapies. Furthermore, we describe strategies to increase the functional maturation of engineered muscle, and motivate the importance of incorporating multiple tissue types on the same chip to model organ cross-talk and generate more predictive drug development platforms. Finally, we review the ability of available in vitro systems to model diseases such as type II diabetes, Duchenne muscular dystrophy, Pompe disease, and dysferlinopathy.
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Affiliation(s)
- Jason Wang
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | | | - Lingjun Rao
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Keith Vandusen
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Nadia Abutaleb
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Nenad Bursac
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
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Salminger S, Sturma A, Hofer C, Evangelista M, Perrin M, Bergmeister KD, Roche AD, Hasenoehrl T, Dietl H, Farina D, Aszmann OC. Long-term implant of intramuscular sensors and nerve transfers for wireless control of robotic arms in above-elbow amputees. Sci Robot 2019; 4:4/32/eaaw6306. [PMID: 33137771 DOI: 10.1126/scirobotics.aaw6306] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 06/20/2019] [Indexed: 11/02/2022]
Abstract
Targeted muscle reinnervation (TMR) amplifies the electrical activity of nerves at the stump of amputees by redirecting them in remnant muscles above the amputation. The electrical activity of the reinnervated muscles can be used to extract natural control signals. Nonetheless, current control systems, mainly based on noninvasive muscle recordings, fail to provide accurate and reliable control over time. This is one of the major reasons for prosthetic abandonment. This prospective interventional study includes three unilateral above-elbow amputees and reports the long-term (2.5 years) implant of wireless myoelectric sensors in the reinnervation sites after TMR and their use for control of robotic arms in daily life. It therefore demonstrates the clinical viability of chronically implanted myoelectric interfaces that amplify nerve activity through TMR. The patients showed substantial functional improvements using the implanted system compared with control based on surface electrodes. The combination of TMR and chronically implanted sensors may drastically improve robotic limb replacement in above-elbow amputees.
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Affiliation(s)
- S Salminger
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.,Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - A Sturma
- Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.,Department of Bioengineering, Royal School of Mines, Imperial College London, South Kensington Campus, Kensington, London SW7 2AZ, UK
| | - C Hofer
- Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.,Otto Bock Healthcare Products GmbH, Brehmstraße 16, A-1110 Vienna, Austria
| | - M Evangelista
- Alfred Mann Foundation, 25134 Rye Canyon Loop #200, Valencia, CA 91355, USA
| | - M Perrin
- Alfred Mann Foundation, 25134 Rye Canyon Loop #200, Valencia, CA 91355, USA
| | - K D Bergmeister
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.,Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - A D Roche
- Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.,Deanery of Clinical Sciences, The University of Edinburgh, Scotland, UK.,Department of Plastic & Reconstructive Surgery, NHS Lothian, Scotland, UK
| | - T Hasenoehrl
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - H Dietl
- Otto Bock Healthcare Products GmbH, Brehmstraße 16, A-1110 Vienna, Austria
| | - D Farina
- Department of Bioengineering, Royal School of Mines, Imperial College London, South Kensington Campus, Kensington, London SW7 2AZ, UK
| | - O C Aszmann
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. .,Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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