Page 196 - Handbook of Biomechatronics

Upper-Limb Prosthetic Devices 193

exteriorization” cineplasty uses tendon transfers combined with skin flaps to
bring a tendon loop outside of the limb (Beasley and de Bese, 1986). The
advantages of this procedure over tunnel cineplasty are:
1. No special procedures for cleaning or ventilating the skin are necessary,
thus eliminating a major cause for infectious complications after surgery.
2. The skin of the tendon exteriorization cineplasty has normal cutaneous
innervation and optimal circulation.
3. The individual motor units are small, hence the number which can be
constructed on a single extremity is limited only by the available inner-
vated skin for use in skin flaps.
4. The system permits selection of either a single muscle or a group of mus-
cles (combined together with a single tendon loop) as the
cineplastic motor.
5. Neither muscle excursion nor power is impaired, since dissection occurs
only in physiological planes and no significant adhesions result from the
surgery.
6. The exteriorized tendons units are esthetically more acceptable than
cineplasty.
The tendon exteriorization procedure is presented in Fig. 10 and is as fol-
lows: the tendon of an undamaged muscle, or a tendon graft attached to it, is
brought up into mobile subcutaneous tissues. The tendon is then enclosed
within a proximally based tubed bipedicle skin flap. This skin flap, being
proximally based, maintains optimal circulation, sensibility, lymphatic
drainage, and remains innervated. The other end of the tendon is looped
back on itself or can be attached either to another muscle or anchored
to bone.

Fig. 10 During tendon exteriorization, the tendon of a selected muscle or a tendon graft
substituted for it, is brought above the surface of the body. A tendon loop is formed and
enclosedina proximallybased,tubed bipedicle flap,thedesign ofwhichresults in minimal
interference with normal cutaneous innervation, vascular supply, and lymphatic drainage.
(From Weir, R.F.f., 1995. Direct Muscle Attachment as a Control Input for a Position-Servo Pros-
thesis Controller (Ph.D. dissertation). Northwestern University, Evanston, IL.)