A North Carolina man who lost three fingers in an industrial accident more than a year ago can now move individual fingers on his prosthetic hand thanks to an innovative surgery by two OrthoCarolina hand surgeons.
Dr. Glenn Gaston, one of the surgeons, said Timothy McCormick, 40, of Laurinburg, is the “first in the world” to be able to move individual fingers of a prosthesis instead of moving them all at the same time.
On the day of McCormick’s accident, Feb. 11, 2015, Dr. Bryan Loeffler, one of Gaston’s partners, initially re-attached three fingers on McCormick’s left hand, but over the next few days, it became apparent they would not survive. That’s when Gaston and Loeffler began brainstorming about what they could do to make a prosthetic hand more functional.
They came up with the idea of transferring muscles from his palm to the back of his hand while “keeping nerves and blood vessels so that they would be alive and still fire,” Gaston said.
“Even when your fingers get cut off, there are muscles that live deep in your palm” that used to move the fingers that were lost, Gaston said. “Those muscles are still there. They just don’t do anything now.”
Partnering with OrthoCarolina Research Institute, the surgeons first tried the procedure on a cadaver hand to see if they could safely move the existing muscle. When it appeared to work, they tried it on McCormick, whose middle finger, ring finger and little finger had been lost.
Gaston said the patient’s surgery, on Feb. 23, 2015, was obviously successful even before he got his prosthesis. To test the results, the doctors placed electrodes on the back of McCormick’s hand and instructed him to think about moving a finger, even though it wasn’t there. Just the thought sent a message to the muscles, now on the back of McCormick’s hand. The electrodes sensed “a sufficiently powerful muscle contraction” to move a prosthetic finger, Gaston said.
About a month ago, the patient was fitted with the prosthesis, and it worked immediately, Gaston said. McCormick was able to simply think about moving his prosthetic fingers and they moved, using the same muscles that had controlled his real fingers before.
Typically, Gaston said, “when you get a prosthetic hand, you then have months of training to learn how to use it,” Gaston said. But with this one, “there literally was no learning. It didn’t take him any time to figure out how to do it.”
In May, Loeffler described the procedure at the First International Symposium on Innovations in Amputation Surgery and Prosthetic Technologies in Chicago. Gaston said the response was “over the top. … Multiple physicians and prosthetists wanted to know, ‘What’d you do? How’d you do this?’ ”
Gaston also discussed the procedure recently at a regional meeting of hand surgeons, including Dr. Bobby Chhabra, chair of orthopedic surgery and chief of hand surgery at the University of Virginia.
Chhabra said he has already talked to Gaston about using it with an appropriate patient. “I hope to try it very soon.”
Prosthetics for patients with upper-extremity amputations are not as advanced as those for lower-extremities, Chhabra said. The latter “are much better for function. You’ve seen so many great success stories with high level athletes.”
Some prosthetics for people who have lost all or part of their hands are purely cosmetic, with little function. Others are mechanical and bulky, with cables attached to a harness that straps to the body and is powered by shoulder motion.
Newer robotic-looking prostheses have individual fingers, but they move as a unit. Amputees operate these myoelectric prostheses by activating sensors placed on the forearm. When forearm muscles contract, the hand moves. But the wearer must learn how to signal the right muscle to move the hand. It doesn’t use the same muscles that moved the real fingers in the past.
“Having individual digit function, controlled by the muscles in your hand, is truly a fantastic advance for these amputees because they can do work that requires more dexterity,” Chhabra said.
That the new procedure was developed by two Charlotte doctors “doesn’t surprise me at all,” Chhabra said. “They are both fantastic surgeons.” He said the high volume of patients served by OrthoCarolina and Carolinas Medical Center would drive the doctors to come up with improvements.
“New ideas would come out of institutions like that,” Chhabra said. “They’re taking care of a lot of trauma, and they’re trying to help patients achieve as much function as possible.”
McCormick’s insurance covered the surgery but not the prosthesis, Gaston said. OrthoCarolina’s research arm provided $25,000 to pay for the artificial hand, and the Hanger Clinic, a prosthetics agency in Charlotte, donated time to build the prosthesis and also help devise the surgery.
Gaston said he and Loeffler are already hearing from others interested in the surgery. One was a New York mother of a 15-year-old who lost half his hand a year ago. Another call came from the local Veterans Affairs hospital concerning several veterans who might benefit.