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The breakthrough, which was reached after a detailed study of the way skin seals around deers’ antlers, paves the way for significant advances in the technology of artificial limbs, including the use of bionic limbs controlled robotically by nerve impulses.
Early trials of the technology are being carried out on a group of patients, including two people who lost arms in the 7/7 bombings in London. Surgeons working with the project say they hope to help many more of the 7/7 survivors requiring replacement limbs and who suffered other injuries.
The advance allows prosthetic arms, legs, thumbs and fingers to be attached directly to the human skeleton using metal implants that protrude through the skin. With the tissue able to seal round the metal link, it is hoped that the longer-term problem of the implant becoming a site of serious infection will finally be overcome.
Researchers at University College London’s Centre for Biomedical Engineering, in collaboration with Stanmore Institute Worldwide, a medical devices firm, have developed a revolutionary technique — Intraosseous Transcutaneous Amputation Prosthesis (ITAP) — to encourage skin tissue to bind to metal.
The technique, which is described in a paper to be published shortly in the Journal of Anatomy, is not simply cosmetic but makes prostheses stronger and more useful.
By connecting the artificial limbs to bone, the skin-sealed metal link creates a better sense of “feel” for patients. Because the limbs are attached to the skeleton, rather than strapped or fixed to a stump, they are designed to be more comfortable and less likely to create pressure sores.
The scientists said that the technique had already been shown to have a significant impact on the lives of people who had, for example, lost thumbs. One patient taking part in the trial was able to use a pen for the first time in ten years.
In the case of a lost thumb, a metal pin would be fixed through the remaining thumb bone, extending either side of the stump through the skin. A prosthesis would then attach to this pin – connecting the false finger directly to the patient’s hand bones. The artificial thumb would then be stronger and have real utility. About 40 per cent of the hand’s utility is lost if a thumb is lost.
The scientists plan to explore the possibility of controlling artificial limbs using electrodes to tap into the patient’s nervous system. This would allow the implant to be controlled bionically. The technology had already been the subject of successful experiments in America, but was hampered by the inability to avoid infection between metal and skin.
About 250,000 people in the US and Europe undergo amputation every year; the new technology could help about 30 per cent of them, especially young people without other health complications.
The breakthrough came about when the research team looked at the way deer antlers grow through animals’ skin. They discovered that by carefully designing the shape of metal implants, and by including a flange beneath the skin and tiny holes, tissue could be encouraged to grow in and around the metal.
The implants consist of a special titanium alloy rod, secured at one end into the bone shaft with the other end passing through the skin.
Gordon Blunn, Professor of Biomedical Engineering at UCL’s Institute of Orthopaedics and Musculo-Skeletal Science, said that the team had looked to nature to work out a way of creating a sealed breach of the skin barrier. He said that after looking at a babirusa, a tusked pig found in Papua New Guinea that has a tooth that passes through the skin of its snout, and human tooth structures, they hit upon the evolutionary technology of antlers.
“We found that the bone structure under the skin was very different to that which was exposed. It was very porous, with lots of tiny holes, which the dermis [inner layer of skin] webs its way into. That was the eureka moment.”
Norbert Kang, a consultant plastic surgeon who has been leading the trials at Mount Vernon Hospital, Hertfordshire, since February last year, said that the team were looking to recruit more suitable candidates, including other bomb victims. They expect to have their 20th patient in trials by this December and believe that the technique could be in wider use within years.
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