Amputation procedures haven't kept pace with prosthetic innovations, a doctor says
One team changes this with a new approach that preserves muscle relationships
The world has watched in wonder as technologists unveil bionic arms and robotic legs. But just as these prosthetic advances offer hope to those who’ve lost limbs, the surgical side of amputations has largely stayed the same, a pioneering doctor said Monday.
A first-of-its-kind amputation procedure, conducted in July, was shared during a news conference at Brigham and Women’s Faulkner Hospital in Boston. “Dynamic-model amputation” may allow the brain to interact with and power a prosthetic – and sense where a limb is without the patient having to look. With a preserved relationship between muscles in concert with prosthetic innovations, Dr. Matthew Carty explained, patients may enjoy restored limb function in new and more natural ways.
The idea of what could be possible was a welcome one for Jim Ewing, 52, who underwent the experimental procedure. An engineer by training, he liked the idea of being part of something visionary.
What life looked like
About two years ago, Ewing, of Maine, fell 50 feet while rock climbing in the Cayman Islands. He landed on his left side and received multiple injuries, including a shattered ankle. No matter the excruciating work he did in physical therapy, severe nerve damage blocked meaningful progress.
He could not walk barefoot. Stepping on a simple grain of sand would fire off sharp and stabbing pain. In shoes, he couldn’t travel 100 feet without stopping in exhaustion and agony. He plowed through medical journals and researched clinical trials, but nothing suggested that his ankle could be saved. He couldn’t bear to live with this sort of pain.
A longtime climber, he reached out to Hugh Herr, a man he’d met 30 years before.
Herr, himself a climber whose legs were amputated below the knees after he was rescued from a 1982 winter climb, had become head of biomechatronics research at the MIT Media Lab. Biomechatronics is a field that combines human physiology with electromechanics in developing bionic limbs. Ewing told Herr he wanted to know what life would look like if he decided to amputate his foot.
Ewing said Herr told him of those who’d struggled for years, only to have their limbs amputated in the end. He also told him how surgeons had generally viewed amputation as a failure.
“Finally,” Ewing said, “he told me about the research he and Dr. Carty were doing. … I was intrigued.”
Soon after meeting with Carty, director of the lower extremity transplant program at Brigham and Women’s Hospital, he was sold.
“It’s now been four months since I had my foot removed. It’s been challenging. I won’t lie,” Ewing said. Nonetheless, he’s “100% certain I made the right decision.”
‘The Ewing Amputation’
A standard amputation cuts feedback between muscles, Carty said. But by creating a tendon pulley system through “the Ewing Amputation” – as this new procedure will be called – muscles can work in relation to one another, and patients can maintain a better connection to the nervous system and to the feeling of limb control.
Carty has been collaborating with other plastic, vascular and orthopedic surgeons as well as Herr’s team at the MIT Media Lab. His work was bolstered in 2014, when he was awarded the first Stepping Strong Innovator Award, established by the The Gillian Reny Stepping Strong Center for Trauma Innovation to fund projects in innovative trauma treatment and recovery. (Reny was 18 when her legs were critically injured – and later saved – during the 2013 Boston Marathon bombing.)