Reconstructive Center for Lost Limbs | Frequently Asked Questions

Individuals who have amputations encounter a variety of daily challenges that can significantly affect their lives, including general health and wellness, mobility, independence and more. The OrthoCarolina Reconstructive Center for Lost Limbs (RCLL) is a multidisciplinary clinic intended to help amputees by offering patients the latest surgical and medical innovations and technology to help them restore maximum limb performance and live life to the fullest.

OrthoCarolina’s multidisciplinary approach ensures that each patient receives a comprehensive, individualized care program.

Our multidisciplinary clinic brings together a team of experts, including surgeons, prosthetists, physical therapists, occupational therapists, and psychologists who collaborate to review each patient's case and determine a care plan that includes the latest advancements in surgical techniques, medical advancements and prosthetic technology.

RCLL is led by world-renowned surgeons Dr. Glenn Gaston and Dr. Bryan Loeffler who view amputation as a reconstructive procedure aimed at maximizing limb function and minimizing discomfort, empowering individuals to regain mobility and independence.

OrthoCarolina’s RCLL is located at the OrthoCarolina Hand Center in Charlotte, N.C., at 1915 Randolph Road.

Yes. Our physicians have extensive experience managing patients having lost multiple extremities and have developed a 10-12 week accelerated program to expedite return to function in these challenging cases.

This program includes “prehab” prior to arrival in Charlotte. Patients are then typically admitted to an Atrium Health hospital where they are evaluated by a team of medical doctors and optimized for surgery. The surgery is a team-based approach with Drs. Gaston and Loeffler often accompanied by additional reconstructive surgeons thereby minimizing surgical time and maximizing the outcomes.

Following surgery patients are started on an accelerated rehab program including OrthoCarolina-created virtual reality therapy, designed to minimize phantom limb pain and have them using prosthetic arms and legs as soon as possible.

Drs. Gaston and Loeffler, along with the OrthoCarolina Research Institute (OCRI), first presented their limb loss research at the Innovations in Amputation Surgery and Prosthetic Technologies meeting in Chicago in 2016 and have since presented their research at multiple national meetings and conferences.

The doctors’ research has been awarded honors from the American Academy of Orthopedic Surgeons (AAOC), the American Foundation for Surgery of the Hand (ASSH), the Society of Military Orthopedic Surgery (SOMOS) and the North Carolina Department of Commerce, among others.

Drs. Gaston and Loeffler have pioneered a multi-pronged approach to amputation recovery and rehabilitation, combining Targeted Muscle Reinnervation (TMR) surgery to manage residual limb pain and Targeted Brain Rehabilitation (TBR) to manage phantom limb pain, addressing the neurological roots of the pain rather than masking it with medications. Together, these treatments have been found to be the optimal pain management strategy for patients.

For prosthesis control to happen there must be active communication between the human-prosthesis interface, and surface myoelectric signals must be detectable to power prosthetics. However, patients with partial or total hand amputations usually lack the requisite number of functioning, detectable muscles for connection. But nerve surgery through Targeted Muscle Reinnervation (TMR) surgery, and muscle transfers such as the STARFISH procedure, can help.

TMR involves redirecting nerves that are used to control the missing limb and connecting them to nearby nerves that are working properly, helping individuals who have lost a limb regain better control over prosthetic devices and reduce pain from the limb that isn't there.

Through TMR, patients can experience significant improvements in pain management and functional outcomes, paving the way for enhanced quality of life post-limb loss.

No surgery can replicate the intricacy of the human hand, however, the STARFISH procedure is allowing us to more closely approximate this goal. Through the STARFISH procedure, partial hand amputees can have the opportunity to be fitted for a myoelectric prosthetic and once again, have the ability to control the movement of individual fingers.

Muscles that run robotics prosthesis are typically too deep within the hand to individual finer movement. So, with the STARFISH procedure, doctors harness muscles deep within the palm of the hand and bring them directly underneath the skin to generate a stronger signal to control a prosthetic digit.

Drs. Glenn Gaston and Bryan Loeffler, through the OrthoCarolina Research Institute (OCRI), have pioneered an evidence-based program known as Targeted Brain Rehabilitation (TBR) that uses Virtual Reality (VR) to prevent phantom limb pain by addressing the neurological roots of the pain rather than masking it with medications.

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.

Nearly 80% of amputees struggle with phantom limb pain. 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.

In select situations, patients are able to receive a temporary prosthetic hand in the first few days and walk in as soon as 4-6 weeks in accelerated cases, though more often 3-4 months may be required to obtain definitive prosthetics. Prosthetists and therapists with extensive experience in multi-extremity limb loss interact with the patients daily for support, while cutting-edge surgical and medical management enable patients the fastest possible recovery.

No. At OrthoCarolina, we are committed to addressing the physical aspects of limb loss while also providing compassionate care that acknowledges the emotional and psychological impact it can have. For example, peer support from other amputees and psychology assistance is also available for all patients undergoing treatment at RCLL.

Whether the result of acute trauma, chronic infection, tumors, or vascular disease, 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.