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Perspectives in Bionic Reconstruction and Post-Amputation Management
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Perspectives in Bionic Reconstruction and Post-Amputation Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine".

Deadline for manuscript submissions: 20 March 2027 | Viewed by 1762

Editors

Prof. Dr. Alexander Gardetto

E-Mail Website
Guest Editor
1. Division of Plastic, Aesthetic and Reconstructive Surgery with Hand Surgery, Brixsana Private Clinic, Julius Durst 28, 39042 Bressanone, Italy
2. Clinic of Plastic, Reconstructive and Aesthetic Surgery, Padova University Hospital, Via Nicolo Giustiniani 2, 35128 Padova, Italy
Interests: bionic reconstruction; advanced nerve interface surgery (TSR/TMR/RPNI/AMI); upper-limb neuroprosthetics; complex peripheral nerve injuries; sensory restoration; phantom-limb pain; reconstructive microsurgery
Special Issues, Collections and Topics in MDPI journals
Dr. Jennifer Ernst

E-Mail Website
Guest Editor Assistant
Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Interests: bionic reconstruction; advanced nerve interface surgery (TSR/TMR/RPNI/AMI); upper-limb neuroprosthetics; complex peripheral nerve injuries; sensory restoration; phantom-limb pain; reconstructive microsurgery

Special Issue Information

Dear Colleagues,

Advances in surgical techniques, postoperative recovery, and rehabilitation after amputation are now central to modern bionic reconstruction. Progress in Targeted Sensory Reinnervation, Targeted Muscle Reinnervation, Agonist–Antagonist Myoneural Interface, Osseointegration, and regenerative strategies such as Regenerative Peripheral Nerve Interfaces, together with next-generation prosthetic systems, is redefining functional restoration. Contemporary prostheses integrate high-resolution sensors, AI-assisted control, and optimized biomechanical design, enabling more natural motor execution and enhanced sensory feedback. Complementary neurorehabilitation protocols and embodiment-focused training further strengthen long-term outcomes.

In this Special Issue, we invite authors to contribute high-quality manuscripts that illuminate current advances and future directions in prosthetic innovation and amputation management.

Prof. Dr. Alexander Gardetto
Guest Editor

Dr. Jennifer Ernst
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • bionic reconstruction
  • advanced prosthetics
  • neurorehabilitation
  • sensory feedback
  • motor control

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Published Papers (2 papers)

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Research

15 pages, 31009 KB  
Article
Transhumeral Amputation with Biceps Tenodesis Sling for Flail Shoulder After Irreversible Brachial Plexus Injury in the Setting of Bionic Reconstruction
by Alexander Gardetto, Gianluca Marcaccini, Ludovico Coldebella, Reinhold Perkmann, Marco Damiano Pipitone, Warren M. Rozen, Ishith Seth and Roberto Cuomo
J. Clin. Med. 2026, 15(13), 5284; https://doi.org/10.3390/jcm15135284 - 6 Jul 2026
Viewed by 586
Abstract
Background: Irreversible brachial plexus injury can leave patients with a painful, insensate, and nonfunctional flail limb, often after failed reconstructive attempts and with limited remaining surgical options. This study describes a modified transhumeral amputation technique incorporating a passive biceps brachii traction sling [...] Read more.
Background: Irreversible brachial plexus injury can leave patients with a painful, insensate, and nonfunctional flail limb, often after failed reconstructive attempts and with limited remaining surgical options. This study describes a modified transhumeral amputation technique incorporating a passive biceps brachii traction sling to improve residual limb stability and prosthetic readiness in this challenging setting. Methods: This retrospective, uncontrolled five-case series assessed the feasibility, perioperative safety, descriptive clinical outcomes, and early prosthetic integration of transhumeral amputation with a biceps brachii-based traction sling. Eligible patients had irreversible brachial plexus palsy, complete loss of useful upper-limb function, chronic shoulder instability or traction-related symptoms, pain, and persistent distress related to the paralysed limb as a burdensome nonfunctional appendage. Outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH) score, Visual Analog Scale (VAS) for pain, and SF-36 Physical Functioning and Emotional Well-Being domains. Results are reported descriptively as individual values and medians without hypothesis testing. Results: All five patients completed follow-up, which reached 30 months. After combined transhumeral amputation, biceps sling construction, RPNI, rehabilitation, and prosthetic fitting, patient-reported scores changed in this small uncontrolled series as follows. The median DASH score changed from 64 preoperatively to 50 postoperatively; in this context, DASH reflects global perceived disability and may be influenced by pain relief, altered expectations, prosthetic compensation, psychosocial adaptation, and the removal of a burdensome limb rather than restoration of upper-limb function. Median VAS pain score changed from 7 to 0; VAS captured overall pain intensity only and did not separately measure phantom limb pain, mechanical pain, neuropathic pain, deafferentation pain, or traction-related symptoms. SF-36 Physical Functioning changed from 75 to 100, and Emotional Well-Being from 75 to 100. Four patients were fitted with a myoelectric prosthesis, and one elected to use a cosmetic prosthesis. No postoperative surgical complications, socket-related complications, prosthesis abandonment, clinical shoulder dislocation, or obvious failure of the construct were observed. Two Paralympic athletes returned to competitive sport after rehabilitation. Conclusions: The combined procedure was technically feasible in five highly selected patients and was not associated with observed surgical or prosthetic complications during follow-up. After combined transhumeral amputation, biceps sling construction, RPNI, rehabilitation, and prosthetic fitting, patient-reported scores improved in this small uncontrolled series. The specific contribution of the biceps sling relative to amputation itself, RPNI, prosthetic rehabilitation, and patient selection remains unknown. Larger prospective studies with objective assessment of shoulder and stump stability are needed to validate these preliminary findings and refine patient-selection criteria. Full article
(This article belongs to the Special Issue Perspectives in Bionic Reconstruction and Post-Amputation Management)
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12 pages, 225 KB  
Article
Comparison of Reoperation and Complication Rates Between Acute and Delayed Advanced Nerve Interface Procedures in Lower-Extremity Amputees
by Kevin Kuan-I Lee, Omer Sadeh, Alberto Barrientos, Anne Genzelev, Omri Ayalon, Nikhil A. Agrawal, Jonathan M. Bekisz and Jacques H. Hacquebord
J. Clin. Med. 2026, 15(2), 882; https://doi.org/10.3390/jcm15020882 - 21 Jan 2026
Cited by 1 | Viewed by 625
Abstract
Background/Objectives: Targeted muscle reinnervation and regenerative peripheral nerve interface procedures have emerged as effective techniques for reducing post-amputation pain and preventing symptomatic neuroma formation. However, the optimal timing of these procedures remains debated. This study aims to compare complication and reoperation rates [...] Read more.
Background/Objectives: Targeted muscle reinnervation and regenerative peripheral nerve interface procedures have emerged as effective techniques for reducing post-amputation pain and preventing symptomatic neuroma formation. However, the optimal timing of these procedures remains debated. This study aims to compare complication and reoperation rates between acute and delayed advanced nerve interface procedures in lower-extremity amputees. Methods: A retrospective cohort study was conducted including 74 patients who underwent acute or delayed targeted muscle reinnervation and/or regenerative peripheral nerve interface procedures between 2019 and 2025 at a tertiary academic medical center. Procedures performed concurrently with amputation or during early-stage reconstruction were classified as acute, whereas procedures performed more than one month after amputation were classified as delayed interventions. The primary outcome was postoperative surgical complications occurring within one year. Mann–Whitney U and chi-square tests were used for group comparisons. Univariable and multivariable logistic regression analyses were performed to identify factors associated with surgical complications, adjusting for potential confounders. A p-value < 0.05 was considered statistically significant. Results: Of 80 limbs, 47 (58.8%) underwent acute and 33 (41.3%) underwent delayed procedures. One-year complication rates were 23.4% in the acute group, and 12.1% in the delayed group, with wound-related complications predominantly occurring in patients undergoing amputation for infection or vascular disease. Unexpected reoperation rates were 19.1% for acute and 12.1% for delayed interventions. On univariable and multivariable analyses, early procedures demonstrated higher odds of surgical complications. However, these associations did not reach statistical significance and were limited by baseline differences in patient comorbidity and etiology. Conclusions: Early advanced nerve interface procedures were performed in more medically complex patients and were associated with higher observed rates of surgical complications, whereas delayed procedures were associated with a higher incidence of recurrent symptomatic neuromas. These findings underscore the importance of patient selection, etiology of amputation, and surgical context, rather than timing alone, when determining the optimal approach to nerve interface reconstruction following lower-extremity amputation. Full article
(This article belongs to the Special Issue Perspectives in Bionic Reconstruction and Post-Amputation Management)
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