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Delivery of UK military upper limb prosthetics: current concepts and future directions
  1. Robert Llewellyn Thomas1,
  2. R Howes2,
  3. L McMenemy3,4,
  4. P Hindle5,
  5. M Wordsworth6 and
  6. R Staruch7
  1. 1Plastic Surgery Department, Southmead Hospital, Bristol, BS10 5NB, UK
  2. 2Burns, Plastic and Reconstructive Surgery, Salisbury NHS Foundation Trust, Salisbury, UK
  3. 3Academic Department of Military Surgery and Trauma (ADMST), Royal Centre for Defence Medicine, Birmingham, UK
  4. 4Centre for Blast Injury Studies, Imperial College London, London, UK
  5. 5Trauma and Orthopaedic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  6. 6Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
  7. 7Department of Plastic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  1. Correspondence to SurgLtCdr Robert Llewellyn Thomas, Plastic Surgery Department, Southmead Hospital, Bristol, UK; rlt{at}


Upper limb prosthetics have a challenging task. A natural upper limb combines strength, coordination and dexterity to accomplish daily activities such as eating, writing, working and social interaction. Artificially replicating these functions requires a prosthetic with composite, synchronous motor function while maintaining sensory feedback and skeletal stability. Achieving these functions requires interfaces between biology and machine across nerve, muscle, bone and skin. This leads to issues related to infection, foreign material encapsulation and implant stability, and electrical signal transduction and interpretation. Over the last 20 years the advent of technologies such as osseointegration, targeted muscle reinnervation, implantable myoelectric sensors, peripheral nerve interfaces and pattern recognition technology has sought to address these problems.

Due to many advances in prehospital care, truncated timelines to damage control surgery and improved combat personal protective equipment, the numbers of amputees have increased with more patients surviving injury. From October 2001 to March 2019 there were 333 amputees from Afghanistan and Iraq compared with 457 fatalities over a similar period. Over a third of these were significant multiple amputees. With a functional, robust upper limb prosthetic which mirrors or exceeds normal function, injured service personnel could be returned to an active combat role. This has benefits for their physical and mental health, improves employability prospects and allows Defence to retain some of its most highly motivated and skilled people who represent significant financial investment.

  • Orthopaedic & trauma surgery
  • Hand & wrist
  • Limb reconstruction

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  • Contributors All authors listed contributed materially to the content of this article. The overall responsibility of the contents and viewpoints lies with the corresponding author, RLT. RH, LM, PH and MW provided editorial advice and recommendations relevant to their areas of special interest, particularly those involving osseointegration and long-term experience of the clinical outcomes. RS has acted in his academic capacity as senior author and editorial oversight in addition to making valuable contributions to the content related to the DMRC.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.