Case repository| Volume 44, ISSUE 2, P163.e1-163.e5, February 2019

Download started.


A Novel Muscle Transfer for Independent Digital Control of a Myoelectric Prosthesis: The Starfish Procedure

      Control of independent digital flexion and extension has remained an elusive goal in myoelectric prosthetics for upper extremity amputees. We first performed a cadaver study to determine the feasibility of transferring the interossei muscles for each digit to the dorsum of the hand without damaging the neurovascular pedicles. Once this capability was ensured, a clinical case was performed transferring the interossei of the middle and ring fingers to the dorsum of the hand where they could serve as a myoelectric signal for a partial hand amputee to allow individual digital control with a myoelectric prosthesis. Before surgery, it was impossible to detect an independent signal for each interossei; however, after the surgery, signals were reliably detected, which allowed these muscles to serve as myosites for finger flexion using a myoelectric prosthesis and move each digit independently. This concept of salvaging innervated and perfused muscles from an amputated part and transferring them into the more proximal and superficial portion of a salvaged limb has broad applications for improved myoelectric prosthetic control.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Farina D.
        • Jiang N.
        • Rehbaum H.
        • et al.
        The extraction of neural information from the surface emg for the control of upper-limb prostheses: Emerging avenues and challenges.
        IEEE Trans Neural Syst Rehabil Eng. 2014; 22: 797-809
        • De Luca C.J.
        • Merletti R.
        Surface myoelectric signal cross-talk among muscles of the leg.
        Electroencephalogr Clin Neurophysiol. 1988; 69: 568-575
        • Schultz A.E.
        • Kuiken T.A.
        Neural interfaces for control of upper limb prostheses: the state of the art and future possibilities.
        PM R. 2011; 3: 55-67
        • Tenore F.V.
        • Ramos A.
        • Fahmy A.
        • Acharya S.
        • Etienne-Cummings R.
        • Thakor N.V.
        Decoding of individuated finger movements using surface electromyography.
        IEEE Trans Biomed Eng. 2009; 56: 1427-1434
        • Atzori M.
        • Müller H.
        Control capabilities of myoelectric robotic prostheses by hand amputees: a scientific research and market overview.
        Front Syst Neurosci. 2015; 9: 162
        • Dumanian G.A.
        • Ko J.H.
        • O'Shaughnessy K.D.
        • Kim P.S.
        • Wilson C.J.
        • Kuiken T.A.
        Targeted reinnervation for transhumeral amputees: current surgical technique and update on results.
        Plast Reconstr Surg. 2009; 124: 863-869
        • McDonnall D.
        • Hiatt S.
        • Smith C.
        • Guillory K.S.
        Implantable multichannel wireless electromyography for prosthesis control.
        Conf Proc IEEE Eng Med Biol Soc. 2012; 2012: 1350-1353
        • Bergmeister K.D.
        • Hader M.
        • Lewis S.
        • et al.
        Prosthesis control with an implantable multichannel wireless electromyography system for high-level amputees: a large-animal study.
        Plast Reconstr Surg. 2016; 137: 153-162