Our Services: Hand and Arm Amputation
Arm transplant recipient Brendan Marrocco with his occupational therapist.Loss of a hand or an arm, whether in a traumatic accident or due to a health condition, is a life-changing experience. At Johns Hopkins, our team of specialists can help you navigate all aspects of limb loss, including evaluation for a hand/arm transplant or conventional/advanced prosthetics, osseointegration, phantom pain and other types physical pain management, rehabilitation programs to address your goals and much more.
Thanks to the combined expertise of our surgeons, physicians, therapists, prosthetists and other team members, we can develop a comprehensive treatment plan to help you restore your ability to interact with the world through your hands as much as possible or find strategies to compensate for specific gaps in function.
Request an Appointment
For more information, call 443-997-9466 to schedule a consultation with our upper-extremity restoration experts.
Our Services
Although not every person is a candidate for these treatments, we help guide patients and their family through the evaluation process to determine the best course of treatment.
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This is an IRB-approved research study (JHM IRB #NA_00046418).
Transplantation of a hand or arm is an operation tailored to each person's needs, type of injury and anatomy. The operation transplants an upper extremity, usually at the level of the forearm or wrist, but sometimes above the elbow, to help restore function after the loss of an arm or hand. Our expert rehabilitation team helps you learn to use the transplanted hand and arm.
Reconstructive surgeons at Johns Hopkins have developed a unique immunosuppression protocol that decreases the number of medications needed to prevent rejection of the transplant. This protocol can help significantly decrease the side effects of the anti-rejection regimen and has been successfully applied in several hand transplant recipients.Who is eligible for a hand/arm transplant?
Not every person who is missing a hand or upper limb is eligible to receive a transplant. Some people find a prosthetic difficult to use, and the lack of sensory “feedback” from the prosthesis can significantly limit their function. Our team can help you decide whether a transplant is right for you.
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Targeted muscle reinnervation (TMR) is a surgical procedure that “re-wires” the nerves that used to control a now missing part of your body, into muscles that are still present. Those nerves can then generate a nerve signal using the new muscle as an amplifier. A modern myoelectric prosthesis, a prosthetic with motors and batteries, can detect that signal and perform a function assigned to that signal, making the use of the robotic prosthesis more natural.
For example, the median nerve, which helps close the hand, could be re-routed into a biceps muscle in the upper arm. Every time a person who is missing their hand tries to close their hand, that portion of their biceps muscle may contract. The prosthesis can detect this and then make the robotic hand close. With expert rehabilitation therapy, the person with a myoelectric prosthesis can experience significantly greater functionality than with a traditional prosthesis.
TMR surgery can also help with chronic nerve-based pain. Studies have found that TMR can reduce the amount of nerve pain people have after amputation, even when performed many years later.Who is eligible for targeted muscle reinnvervation?
In general, those who still have peripheral nerves to an absent limb and have problems with chronic nerve-based pain or who want to improve their functionality with myoelectric prosthetics may be eligible. People who have had spinal cord injuries which affected their peripheral nerves so that they no longer function are not typically candidates. It is not known how well TMR works for people born with absent limbs and it is not widely used to help people with this condition.
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The rehabilitation team includes rehabilitation physicians, physical and occupational therapists, prosthetists, nurses and rehabilitation psychologists.
Each of these specialists plays an important role in helping you get the training and develop the confidence you need to live your life to the fullest despite the limb loss.
Our rehabilitation approach includes:
- Evaluation
- Education
- Prosthesis prescription and monitoring
- Occupational therapy for hand and arm prosthetics and orthotics
- Phantom pain management
- Rehabilitation psychology to help address psychological effects of limb loss.
Call 443-997-5476 to request an appointment.
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Osseointegration is a surgical procedure that aims to offer better quality of life and improved function and mobility to people who have had an amputation. Surgery involves inserting a metal implant into the bone of a residual limb, which then attaches directly to a prosthesis, eliminating socket-related issues. Surgery can be performed in one or two stages, depending on the implant system.
Watch a video on the osseointegration procedure.
Fill out this form to see if you are a candidate for this procedure.
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Reconstructive microsurgery involves moving tissue from one part of the body to another to reconstruct an area of need. This tissue transfer or free flap surgery can involve moving skin, fat, muscle, and/or bone. To keep the tissue alive, the blood vessels that supply the perfusion of the tissue being moved are re-connected, or anastomosed, to blood vessels in the area of the body that is being reconstructed. This is similar to a transplant of your own tissue. The most common reasons for patients to undergo this type of surgery are cancer, trauma, and infection.
The goal of the flap surgery is to reconstruct the form and function of the missing tissue. This may involve reconnecting nerves to allow muscle function or skin sensation, or using tissue that more naturally recreates the feel of the missing tissue.
Featured News Stories
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Double Arm Transplant Recipient: Brendan Marrocco
In December 2012, a surgical team performed The Johns Hopkins Hospital’s first bilateral arm transplant, together with an innovative treatment to prevent rejection of the new limbs.
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Electronic ‘Skin’ to Enable People with Amputations to Perceive Through Prosthetic Fingertips
The technology was developed out of fabric and rubber laced with sensors to mimic nerve endings.