Surgical technique| Volume 44, ISSUE 11, P997.e1-997.e6, November 2019

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Pedicled Serratus Anterior Flap as an Alternative Muscle Target for Targeted Muscle Reinnervation in Transhumeral Amputees

Published:September 17, 2019DOI:
      Upper limb amputation is a universally devastating injury that results in substantial loss of function. Myoelectric prostheses represent a new generation of battery-powered programmable prostheses controlled by EMG signals. The aim of upper limb targeted muscle reinnervation (TMR) is to enhance the control of a myoelectric prosthesis by improving the number and quality of EMG signals that can be used to control prosthetic elbow, wrist, and hand movements. Current TMR techniques rely on preservation of parts of biceps and triceps to be used as reinnervated muscle targets. However, a subset of amputations exists in which the proximity or mechanism of injury results in loss of these local muscle targets, making these techniques less suitable. Alternative muscles beyond the zone of injury must be sought and imported as targets for residual nerves. Through its neurovascular anatomy and physical structure, the serratus anterior offers multiple potential targets in close vicinity to the upper limb, making the creation of additional signals through a single flap achievable in this challenging scenario. We present our technique using a pedicled serratus anterior muscle flap as an alternative muscle target in transhumeral amputees undergoing TMR.

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