
During a recent conversation a friend of mine complained that she found missing appendages unsettling. Ever anxious to resolve such problems, I began musing about the basically poor standard of prosthetic limbs available to amputees. The NHS for example, continues to issue devices which have not progressed since the 17th century, (Hooks for God's sake!). This, clearly is ridiculous and cannot continue. I have been paying particular attention to that most crucial of appendages,* the hand. If a hand must be amputated, the resultant loss of dexterity significantly impacts on the unfortunate amputee, but much of the mobility of the hand is controlled, not by muscles in the hand itself, but by tendons attached to muscles in the forearm. The 'gripping' action is entirely controlled thus. Some of the more advanced prostheses now available are able to detect nerve impulses in the stump, and translate these into signals controlling motors in the bionic hand, but this seems overly complicated to me; why not simply attach artificial tendons to the remnants inside the forearm, and have these control the fingers and the wrist movements directly? This would restore much of the mobility of the hand, although a number of muscles, such as those controlling the thumb, would still have to be restored electronically. Since such an arrangement would require a direct interface between the interior of the wrist and the prosthesis, the latter would have to be hermetically sealed and permanently attached. in any case, to my mind, since the original hand was a permanent attachment, any replacement should be as well. This poses the problem of how to create an interface between the skin and the prosthesis. My proposed solution is simply to implant a layer of inert polymer mesh within the dermis or the subcutis, such that skin may continue to grow through it, but will be permanently anchored to it. It in turn is anchored to the prosthetic, resulting in permanent attachment (See illustration). Hopefully a polymeric material can be selected which will not provoke the dreaded Foreign Body Reaction, while the problem still remains of how best to power the small number of motors still required within the prosthesis. For the sake of permanence, one of those plutonium based radioisotope thermoelectric generators used for powering pace-makers seems like the best option.
*(Second most crucial to those of us with a Y chromosome).



