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Bionic Hand Reconstruction Successfully Reduces Deafferentation Pain in Patients with Brachial Plexus Avulsion Injury
Laura Antonia Hruby, MD; Stefan Salminger, MD; Johannes Mayer, MD; Agnes Sturma, Bsc Msc; Oskar C. Aszmann, MD; PhD
Medical University of Vienna, Vienna, Austria

Introduction: Root avulsions of the brachial plexus represent one of the most severe nerve injuries. Next to apparent sensorimotor deficits, the avulsion injury often leads to unbearable pain in the arm and hand, frequently referred to as deafferentation pain. In avulsion injuries of the inferior trunk the burden of pain is most intense and hand function that can be expected by reconstructive surgery (intra-/extraplexual nerve transfers) is less than poor. Here, we report of seven patients with global brachial plexopathies with multiple root avulsions, who have approached our specialist center of extremity reconstruction in the years of 2011 to 2016. The impact of bionic hand reconstruction on hand function, deafferentation pain and quality of life is presented.

Materials & Methods: In all seven patients selective nerve transfers (and muscle transfers in selected cases) were performed but in some did not avail sufficient hand function. However, thereby generated electromyographic signals could be used for the control of a prosthetic device. After intense rehabilitative training and consequent intuitive signal control, the functionless hand was electively amputated and replaced by a prosthetic hand, a procedure now defined as “bionic reconstruction”. Pain was assessed with the Visual Analogue Scale (VAS). Additionally pre-and post-interventional pain medication was documented and quality of life as well as general health were assessed on a regular basis (Health Survey SF-36). Patients were evaluated pre-interventionally, during the rehabilitative process and after amputation as well as after final prosthetic fitting.

Results: Bionic hand reconstruction led to significant pain reduction compared against pre-interventional pain conditions. Pain medication intake could be reduced in all patients after the prosthetic hand had been incorporated into the user’s activities of daily living. Quality of life, subjectively perceived health state, and psychological role functioning also improved significantly.

Conclusion: The functional and cognitive re-integration of the extremity into the patient’s body image led to major pain relief as well as markedly improved quality of life in all so far treated patients. In some patients even a re-entry into working life was permitted by the functional gain of the prosthetic hand, which also came along with social and economic benefits.

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