Reinventing Extremity Amputation in the Era of Functional Limb Restoration

Hugh M. Herr, Tyler R. Clites, Shriya Srinivasan, Simon G. Talbot, Gregory A. Dumanian, Paul S. Cederna, Matthew J. Carty*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

34 Scopus citations


Background:Recent progress in biomechatronics and vascularized composite allotransplantation have occurred in the absence of congruent advancements in the surgical approaches generally utilized for limb amputation. Consideration of these advances, as well as of both novel and time-honored reconstructive surgical techniques, argues for a fundamental reframing of the way in which amputation procedures should be performed.Methods:We review sentinel developments in external prosthetic limb technology and limb transplantation, in addition to standard and emerging reconstructive surgical techniques relevant to limb modification, and then propose a new paradigm for limb amputation.Results:An approach to limb amputation based on the availability of native tissues is proposed, with the intent of maximizing limb function, limiting neuropathic pain, restoring limb perception/proprioception and mitigating limb atrophy.Conclusions:We propose a reinvention of the manner in which limb amputations are performed, framed in the context of time-tested reconstructive techniques, as well as novel, state-of-the-art surgical procedures. Implementation of the proposed techniques in the acute setting has the potential to elevate advanced limb replacement strategies to a clinical solution that perhaps exceeds what is possible through traditional surgical approaches to limb salvage. We therefore argue that amputation, performed with the intent of optimizing the residuum for interaction with either a bionic or a transplanted limb, should be viewed not as a surgical failure, but as an alternative form of limb reconstruction.

Original languageEnglish (US)
Pages (from-to)269-279
Number of pages11
JournalAnnals of surgery
Issue number2
StatePublished - Feb 1 2021


  • agonist-antagonist myoneural interface
  • amputation
  • functional limb restoration
  • limb reconstruction
  • regenerative peripheral nerve interface
  • targeted muscle reinnervation
  • vascularized composite allotransplantation

ASJC Scopus subject areas

  • Surgery


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