{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T01:48:28Z","timestamp":1791942508468,"version":"4.3.4"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Global brachial plexus lesions with multiple root avulsions are among the most severe nerve injuries, leading to lifelong disability. Fortunately, in most cases primary and secondary reconstructions provide a stable shoulder and restore sufficient arm function. Restoration of biological hand function, however, remains a reconstructive goal that is difficult to reach. The recently introduced concept of bionic reconstruction overcomes biological limitations of classic reconstructive surgery to restore hand function by combining selective nerve and muscle transfers with elective amputation of the functionless hand and its replacement with a prosthetic device. The authors present their treatment algorithm for bionic hand reconstruction and report on the management and long-term functional outcomes of patients with global brachial plexopathies who have undergone this innovative treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Thirty-four patients with posttraumatic global brachial plexopathies leading to loss of hand function consulted the Center for Advanced Restoration of Extremity Function between 2011 and 2015. Of these patients, 16 (47%) qualified for bionic reconstruction due to lack of treatment alternatives. The treatment algorithm included progressive steps with the intent of improving the biotechnological interface to allow optimal prosthetic hand replacement. In 5 patients, final functional outcome measurements were obtained with the Action Arm Research Test (ARAT), the Southampton Hand Assessment Procedure (SHAP), and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>In all 5 patients who completed functional assessments, partial hand function was restored with bionic reconstruction. ARAT scores improved from 3.4 \u00b1 4.3 to 25.4 \u00b1 12.7 (p = 0.043; mean \u00b1 SD) and SHAP scores improved from 10.0 \u00b1 1.6 to 55 \u00b1 19.7 (p = 0.042). DASH scores decreased from 57.9 \u00b1 20.6 to 32 \u00b1 28.6 (p = 0.042), indicating decreased disability.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The authors present an algorithm for bionic reconstruction leading to useful hand function in patients who lack biological treatment alternatives for a stiff, functionless, and insensate hand resulting from global brachial plexopathies.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.6.jns16154","type":"journal-article","created":{"date-parts":[[2017,1,17]],"date-time":"2017-01-17T09:04:25Z","timestamp":1484643865000},"page":"1163-1171","source":"Crossref","is-referenced-by-count":43,"title":["Algorithm for bionic hand reconstruction in patients with global brachial plexopathies"],"prefix":"10.3171","volume":"127","author":[{"given":"Laura A.","family":"Hruby","sequence":"first","affiliation":[{"name":"Christian Doppler Laboratory for Restoration of Extremity Function;"},{"name":"Department of Physical Medicine and Rehabilitation; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnes","family":"Sturma","sequence":"additional","affiliation":[{"name":"Christian Doppler Laboratory for Restoration of Extremity Function;"},{"name":"Department of Physical Medicine and Rehabilitation; and"},{"name":"Master Degree Program, Health Assisting Engineering, University of Applied Sciences FH Campus, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes A.","family":"Mayer","sequence":"additional","affiliation":[{"name":"Christian Doppler Laboratory for Restoration of Extremity Function;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Pittermann","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Salminger","sequence":"additional","affiliation":[{"name":"Christian Doppler Laboratory for Restoration of Extremity Function;"},{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oskar C.","family":"Aszmann","sequence":"additional","affiliation":[{"name":"Christian Doppler Laboratory for Restoration of Extremity Function;"},{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns16154","series-title":"Pain","doi-asserted-by":"publisher","first-page":"1923","DOI":"10.1016\/j.pain.2011.03.037","article-title":"Dorsal root entry zone lesioning for pain after brachial plexus avulsion: results with special emphasis on differential effects on the paroxysmal versus the continuous components. 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