Limb Loss as Salvage: Reinventing Extremity Amputation for the 21st Century
Matthew J. Carty, MD1; Hugh Herr, PhD2; Tyler R Clites, PhD3; Shriya S Srinivasan, BS2; Simon G. Talbot, MD4; Gregory A. Dumanian, MD5; Paul S. Cederna, MD6
1Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, 2Massachusetts Institute of Technology, Cambridge, MA, 3MIT, Cambridge, MA, 4Division of Plastic Surgery, Brigham & Women's Hospital, Boston, MA, 5Division of Plastic Surgery, Northwestern University, Chicago, IL, 6Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI
In light of dramatic advancements in external prosthetic limb technology and limb transplantation, the standard surgical paradigm for amputation is outdated. We here propose a reinvention of the manner in which limb amputation is performed, framed in the context of time-tested reconstructive techniques, as well as novel, state-of-the-art surgical procedures. Implementation of the proposed techniques in the acute setting has the potential to elevate advanced limb replacement strategies to a clinical solution with outcomes on par with, or perhaps exceeding, what is possible through traditional surgical approaches to limb salvage. We therefore argue that amputation, performed with the intent of optimizing the residuum for interaction with either a bionic or a transplanted limb, should be viewed not as a surgical failure, but as an alternative form of limb reconstruction.
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