• Hugh M Herr, Tyler R Clites, Shriya Srinivasan, Simon G Talbot, Gregory A Dumanian, Paul S Cederna, and Matthew J Carty.
• Massachusetts Institute of Technology, Center for Extreme Bionics, Cambridge, MA.
• Ann. Surg. 2021 Feb 1; 273 (2): 269279269-279.

BackgroundRecent progress in biomechatronics and vascularized composite allotransplantation have occurred in the absence of congruent advancements in the surgical approaches generally utilized for limb amputation. Consideration of these advances, as well as of both novel and time-honored reconstructive surgical techniques, argues for a fundamental reframing of the way in which amputation procedures should be performed.MethodsWe review sentinel developments in external prosthetic limb technology and limb transplantation, in addition to standard and emerging reconstructive surgical techniques relevant to limb modification, and then propose a new paradigm for limb amputation.ResultsAn approach to limb amputation based on the availability of native tissues is proposed, with the intent of maximizing limb function, limiting neuropathic pain, restoring limb perception/proprioception and mitigating limb atrophy.ConclusionsWe propose a reinvention of the manner in which limb amputations are performed, framed in the context of time-tested reconstructive techniques, as well as novel, state-of-the-art surgical procedures. Implementation of the proposed techniques in the acute setting has the potential to elevate advanced limb replacement strategies to a clinical solution that perhaps exceeds what is possible through traditional surgical approaches to limb salvage. We therefore argue that amputation, performed with the intent of optimizing the residuum for interaction with either a bionic or a transplanted limb, should be viewed not as a surgical failure, but as an alternative form of limb reconstruction.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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