Reconstructive Center for Lost Limbs

Multidisciplinary Approach to Amputation Care

At the OrthoCarolina Reconstructive Center for Lost Limbs (RCLL), we bring together a multidisciplinary team of experts to offer the latest advancements in surgical techniques and prosthetic technology. We view amputation as a reconstructive procedure aimed at maximizing limb function and minimizing discomfort, empowering individuals to regain mobility and independence. Our commitment is not only to address the physical aspects of limb loss but also to provide compassionate care that acknowledges the emotional and psychological impact it can have.

Comprehensive Monthly Clinics

Each month, our clinics are led by renowned orthopedic surgeons Dr. Glenn Gaston and Dr. Bryan Loeffler. You will benefit from the expertise of prosthetists/orthotists, occupational therapists, and psychologists who work collaboratively to address every aspect of your care. From single-digit amputations to 4-limb amputees, our clinic offers innovative procedures tailored to your individual needs, including nerve-mediated pain management and cutting-edge techniques such as targeted muscle reinnervation (TMR), regenerative peripheral nerve interface (RPNI), the Starfish procedure, and targeted brain rehabilitation (TBR) using virtual reality.

Innovations from the OrthoCarolina Reconstructive Center for Lost Limbs

At the OrthoCarolina Reconstructive Center for Lost Limbs, we are at the forefront of pioneering techniques and treatments that significantly enhance the quality of life for our patients. Our innovative approaches are designed to address both the physical and neurological challenges associated with limb loss.

Cutting Edge Surgical Treatments: Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interface (RPNI)

In recent years, significant surgical advancements have been made to enhance prosthetic control for amputees.  Nerve management strategies such as targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) surgeries have helped to minimize nerve pain in the residual limb as well as enable better control of robotic limbs.  Novel muscle transfers, such as the starfish procedure, have allowed the first patients in the world independent finger control of prosthetics.  Prior to these innovative procedures, control of prosthetics was far inferior and much less intuitive and therefore patients abandoned prosthetics at a much higher rate.

Starfish Procedure

The Starfish Procedure, developed in Charlotte, North Carolina by Drs. Gaston and Loeffler, enabled the first patient in the world to have independent finger control of a prosthetic. This procedure involves transplanting muscles from deep within the palm to the back of the hand where the signals can be detected by a prosthesis and intuitive control of each finger on the prosthesis is possible. This groundbreaking surgery was featured on CNN, Fox News, and 60 Minutes. 

Targeted Muscle Reinnervation (TMR) and Regenerative Peripheral Nerve Interface (RPNI) Procedures

Targeted Muscle reinnervation is a surgical procedure that involves using the cut nerve endings from an amputation to reinnervate other remaining muscles in the limb to both limit nerve pain in the arm and better control prosthetics. RPNI is a procedure in which the cut nerve endings from an amputation are wrapped with a muscle graft to prevent neuroma formation.

TMR and RPNI are frequently used in conjunction during complex amputation cases.  These procedures can be used for a variety of amputation types including trauma, infection, and tumor.  Through TMR, patients can experience significant improvements in pain management and functional outcomes, paving the way for enhanced quality of life post-limb loss.  Drs. Gaston and Loeffler not only perform these surgeries on a routine basis, but also have a monthly clinic in which they teach visiting surgeons these techniques.

Innovative Non-Surgical Techniques: Targeted Brain Rehabilitation (TBR) for Phantom Limb Pain Management Using Virtual Reality

Phantom limb pain is a common and challenging issue for amputees, with up to 80% struggling with this condition. This pain, often described as burning or clenching in the missing limb, results from the brain's response to the loss of the limb. Following the loss of a limb, the section of the brain that controls the missing limb becomes vacant and the void is filled with static “noise” which is perceived as pain.

Drs. Gaston and Loeffler, through the OrthoCarolina Research Institute (OCRI), are developing an evidence-based program known as Targeted Brain Rehabilitation (TBR) that uses Virtual Reality (VR) to heal this vacant section of the brain. This innovative approach aims to prevent and treat phantom limb pain by addressing the neurological roots of the pain rather than masking it with medications.

Their ongoing study seeks to prove that targeted brain rehabilitation using VR can reduce phantom limb pain. Preliminary results are extremely encouraging, and their research has won grant support from the American Foundation for Surgery of the Hand. The combination of TMR to manage the residual limb pain and TBR to manage the phantom limb pain holds tremendous promise as the optimal pain management strategy for patients.

Read more about Health Care Innovator Award.

Make an Appointment

Whether the result of chronic infection, tumors, vascular disease, or trauma, we approach each case with a focus on definitive treatment, functional restoration, and pain management. At the OrthoCarolina Reconstructive Center for Lost Limbs, we understand the sensitivity of this journey and are here to support you every step of the way.To make an appointment with the Reconstructive Center for Lost Limbs, please email RCLL@orthocarolina.com.

For media inquiries related to the Reconstructive Center for Lost Limbs and any of our pioneering treatments and therapies, please reach out to marketing@orthocarolina.com

Recognition

Awards:

2024 Resident & Fellow Fast Track Grant Award, American Foundation for Surgery of the Hand (AFSH): Frix JT, Gaston RG, Johnsen K, Loeffler BJ, Serbin RP. Understanding and Treating the Phantom Limb with Virtual Reality: Research.

2023 AAOS Annual Meeting Honorable Mention Best Video Theater Contribution: Mastracci JC, Gaston RG, Loeffler BJ. Regenerative peripheral nerve interfaces and targeted muscle reinnervation: Surgical technique. American Academy of Orthopedic Surgery Annual Meeting. Mar 7-11 2023. Las Vegas NV.

2022 Jamie Dianne Bulken-Hoover Award for Best Hand Paper at the Society of Military Orthopedic Surgery (SOMOS). Acute versus delayed targeted muscle reinnervation for upper extremity amputees. Posey L, Loeffler B, GastonRG.

2022 First Place Video Theater Presentation American Society for Surgery of the Hand (ASSH) Annual Meeting. Regenerative peripheral nerve interfaces and targeted muscle reinnervation: Surgical technique. Mastracci J, Loeffler B, Gaston RG.

2021 ASSH Top 5 Paper. Managing Digital Nerve Neuromas. Maslow J, Gaston, RG, Loeffler B.

JE Hanger Award for Innovation, 2020

AAOS Award Winning Movie: Gaston RG, Loeffler BJ, Tait MA, Bracey JW. Targeted Muscle Reinnervation and Its Role in Acute Management of Above Elbow Amputations; AAOS Annual Meeting; 2017 Mar 14-18; San Diego, CA

NCNextFirsts Award 2016: North Carolina Department of Commerce Acknowledgement of the top innovative accomplishments in the history of the state of NC.

Publications:

Cohen-Tanugi S, Reid R, Loeffler BJ, Gaston RG. The Prevalence of Depression and PTSD in Adults With Surgically Managed Traumatic Upper-Extremity Amputations. Hand (N Y). 2024 Jan;19(1)169-174.

Chow I, Gaston RG. Transradial amputation and wrist disarticulation. Op Tech in Orthop. 2023 Sep 33(3):1-9.

Saltzman EB, Jerome JTJ, Gaston RG. Current concepts and management of upper limb amputees. J Hand Microsurg 2023 Aug 25;15(4):245-246

Maslow JI, LeMone A, Scarola GT, Loeffler BJ, Gaston RG. Digital Nerve Management and Neuroma Prevention in Hand Amputations. Hand (N Y). 2023 Jul;18(5):838-844.

Guerrero EM, Mastracci JC, Gart MS, Garcia RM, Loeffler BJ, Gaston RG. Soft tissue management of partial hand amputation. J Hand Surg Am. 2023 Jun;48(6):612-618.

Eberlin KR, Brown DA, Gaston RG, Kleiber GM, Ko JH, Kovach SJ, Loeffler BJ, MacKay BJ, Potter BK, Roubaud MS, Souza JM, Valerio IL, Dumanian GA. A consensus approach for targeted muscle reinnervation in amputees. Plast Reconstr Surg Glob Open. 2023 Apr 5;11(4):e4928.

Denduluri SK, Rees A, Nord KM, Loeffler BJ, Gaston RG. The Starfish Procedure for Independent Digital Control of a Myoelectric Prosthesis.Tech Hand Up Extrem Surg. 2023 Mar 1;27(1):61-67.

Hysong AA, Melamed E, Delarosa MR, Daley DN, Loeffler BJ, Gaston RG. Feasibility of Nerve Transfer to Palmaris Longus in Forearm-Level TMR: Anatomic Study and Clinical Series Hand (N Y). 2022 Dec 12:15589447221137615. doi: 10.1177/15589447221137615. 

Reid RT, Johnson CC, Gaston RG, Loeffler BJ. Impact of timing on targeted muscle reinnervation on pain and opiod intake following major limb amputation. Hand (N Y). 2022 Jul 13:15589447221107696. doi: 10.1177/15589447221107696.

Grier AJ, Loeffler BJ, Gaston RG. Starfish Procedure. Hand Clin. 2021 Aug;37(3):447-455. doi: 10.1016/j.hcl.2021.04.007.

Johnson CC, Loeffler BJ, Gaston RG. Targeted Muscle Reinnervation: A Paradigm Shift for Neuroma Management and Improved Prosthesis Control in Major Limb Amputees. J Am Acad Orthop Surg. 2021 Apr 1;29(7):288-296. doi: 10.5435/JAAOS-D-20-00044.

Geary M, Gaston RG, Loeffler B. Surgical and technological advances in the management of upper limb amputees. Bone Joint J. 2021 Mar;103-B(3):430-439. doi: 10.1302/0301-620X.103B3.BJJ-2020-1184.R1.

Kaluf B, Gart MS, Loeffler BJ, Gaston G. Evaluating the Ability of Congenital Upper Extremity Amputees to Control a Multi-Degree of Freedom Myoelectric Prosthesis. J Hand Surg Am. 2021 Oct 14:S0363-5023(21)00523-2. doi: 10.1016/j.jhsa.2021.08.011.

Gaston RG. “Team Approach: Modern Day Prosthetics in the Mangled Hand.” JBJS Reviews. July 16, 2019 issue

Pierrie SN, Gaston RG, Loeffler BJ Targeted Muscle Reinnervation for Prosthesis Optimization and Neuroma Management in the Setting of Transradial Amputation. J Hand Surg Am. 2019 Jun;44(6):525.e1-525.e8. doi: 10.1016/j.jhsa.2018.11.019. Epub 2019 Feb 4. Review. PMID: 30733097

Gaston RG , Bracy J, Loeffler BJ, Tait M. “A Novel Muscle Transfer for Independent Digital Control of Myoelectric Prosthesis: The Starfish Procedure.” Journal of Hand Surgery AM 2019 Feb:44(2):163

Pierrie S, Gaston RG, Loeffler BJ. Current Concepts in Upper Extremity Amputations. Journal of Hand Surgery 2018 Jun 2

Gaston RG, Loeffler BJ: “Introducing the Starfish Procedure.” AAOS Now. 2018 Mar

Tait MA, Bracey JW, Loeffler BJ, Gaston RG. (Published Abstract) “Targeted Muscle Reinnervation and its Role in Acute Management of Above-Elbow Amputations.” JAAOS 2017 Sept;25(9)