(Source: LucasFilm Ltd.)
Elective amputation is very groundbreaking, controversial

It's many people's worse nightmare -- a crippling car accident.  Describes Nicola Wilding, 35, "Twelve years ago on the motorway coming back from Brighton (UK) I had a crash.  In the impact I brought my arm up to protect my head and it's pulled the nerves and the shoulder back. I broke the bones straight across - compound fractures I think here and here."

I. Robbed of Her Freedom

Suddenly the UK native found her life drastically changed as her arm was crippled, even though the flesh and bone healed under careful medical care.  Ms. Wilding elected for the most advanced treatment at the time, implanting nerve-containing chunks of flesh taken from her leg and arm into her should-to-arm connecting region, dubbed the brachial plexus.

Brachial Plexus
The brachial plexus is the shoulder region containing the brain's sensitive "connector cable"
to the arm and hand. [Image Source: SPL]

The approach worked -- almost.  But the most vital tool of mankind -- its hands -- never responded even as she regained movement.  She tells BBC News in an interview, "My doctors are like 'That's all we can do for you.'  It's the everyday things. If you go to butter toast you can't hold it. I've used my teeth to open bottles and chipped some teeth. Taking my clothes off, having a shower. I have to have meals prepared for me - I can't peel a potato as much as I've tried. I'd probably end up injuring myself.   There are things I just can't do."

Nicola Wilding
Nicola Wilding, crash victim, talks with Viennese surgeon Oskar Aszmann, an expert in bionics and pioneer in elective amputation. [Image Source: BBC News]

But the crash victim's suffering may finally be at an end thanks to a wild medical decision that's raising a lively round of bioethics debate -- elective amputation.

II. Elective Amputation, a Very New Procedure, Helped Similar Victims

Elective amputation involves cutting of a damaged body part to install a cybernetic solution.  A true digital age solution, the doctors leverage robotic hands, with sensors monitoring nerves in the lower arm which allow the patient to relearn use and perform complex tasks, regaining their freedom.

Some in the medical and bioethics field have voiced concerned about the procedure given its permanent nature and the chance that a more organic solution could later be found.  But for the handful of patients who have experienced it, they are all elated to regain basic hand use.

The first ever patient to receive the procedure was named Patrick.  After being electrocuted at work he lost his fingers.  A second elective amputee came in 2011 in a case similar to Ms. Wilding's.  Named Milo, the man was vacationing in his native homeland of Serbia when his motorcycle skidded into a lamppost damaging his brachial plexus.  Nerve replacement (such as Ms. Wilding received) combined with elective amputation gave him movement.

Both men were able to perform, after a bit of training, relatively complex tasks, such as holding a glass or tieing their shoes.  That's thanks to German prosthesis maker Otto Bock (makers of the "Michelangelo" hand) and the UK's Touch Bionics (maker of the  "i-Limb"), whose bionic hands deliver force carefully enough not to break objects, but sufficient to prevent them from slipping lose.

Michelangelo hand
Otto Bock's "Michelangelo" bionic hand offers unprecedented control.
[Image Source: Popular Science]

III. A New Hand for Nicola

Inspired by hearing about Milo's story, Ms. Wilding visited Dr. Oskar Aszmann, the Vienna, Austria based surgeon who performed the procedure on Milo.  Dr. Aszmann recalls the meeting, remembering that he was careful to state the risk.

"These are risky decisions - they are irreversible. Once the extremity is gone it's gone, you cannot put it back on again," he comments, "(But) she's already ready to go. She says she wants to have a functional hand and arm, so I think for her there's no question in her mind."

"What we have to figure out is what she still needs to qualify for an elective amputation and I think for that she will need to come to Vienna for us to conduct thorough tests."

The final step is for Ms. Wilding to go through tests to demonstrate that her lower arm nerves were sufficiently responsive to power the bionic hand.  If they're successful the path is cleared for Ms. Wilding to become only the third hand damage victim to elect amputation and bionic replacement.

Source: BBC News

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