Page 193 - Handbook of Biomechatronics

190 Georgios A. Bertos and Evangelos G. Papadopoulos

motivated candidates. Only tunnels capable of adequate force and excursion
were recommended early in the century, since all the prostheses were body
powered. For that reason, most of the time, below-elbow amputees were
treated with biceps tunnel cineplasty and above elbow or shoulder disartic-
ulation cases were treated with pectoral tunnel cineplasty. To make the
biceps tunnel, incisions are made along three sides of a rectangle (Fig. 7)
to permit elevating a skin flap containing skin, fat, and fascia while retaining
blood and nerve supply through the fourth side (Fig. 7). The skin flap is
rolled into a tube (Fig. 7) with the skin surface inside, and the distal end
of the muscle is itself detached to form a smooth surface (Fig. 7). The muscle
fibers are separated with a dilator (Fig. 7), not cut transversely, to form a pas-
sage through which the skin tube can be drawn and rotated to prevent the
pin from pressing on the scar (Fig. 7). A skin graft covers the defect
remaining after the skin tube is sutured in place with its ends flared back over
the muscle surface (Fig. 7). Petroleum-jelly gauge is placed in the tunnel
(Fig. 7) before application of a pressure dressing. An example of a prosthesis
suitable for a below-elbow amputee having biceps tunnel cineplasty is
shown in Fig. 8. A pin is inserted through the muscle tunnel. A Bowden
cable is running from this pin to the prosthesis providing a rigid mechanical
linkage, necessary for the implementation of EPP. Contraction of the
cineplastized muscle causes the pin to move and the Bowden cable to move
and the terminal device to open, or close depending if it is voluntary-
opening or voluntary-closing device. For above-elbow amputees, biceps
tunnel cineplasty has been used in the past by some surgeons. Also, the
pectoralis major muscle has been used by others. The surgical technique
involved in constructing the pectoral tunnel parallels that for the case, the
base of the skin flap is either toward the axilla or across the lower side.
For example prosthesis for an above-elbow amputee having pectoral
cineplasty is shown in Fig. 9.
It was only after the World War II that amputation surgery and prosthet-
ics research received proper attention in the United States. This was due the
large number of amputated soldiers after the war. In 1945 the Committee on
Artificial Limbs of the National Research Council was created, with the goal
to organize and execute the needed improvements so that veteran amputees
could have access to the best available prostheses. After extensive travel to
Europe the Committee’s most important finding was the Sauerbruch tunnel
cineplasty procedure modified by Lebsche. This procedure is now known in
the United States as the Sauerbruch/Lebsche procedure (Fig. 8). Numerous
cineplasty procedures were performed after the war in the United States.