Figure 2.

(A) Despite complete muscle atrophy in the patient’s forearm a fascicle group containing viable motor axons was identified in the median nerve with an intra-operative fast staining method screening for acetylcholine positivity. (B) A free functional muscle, i.e., the gracilis muscle from the patient′s leg, was transferred to the medial upper arm and its muscle nerve branch (the obturator nerve) was co-apted to the fascicle group previously tested positive for the presence of functional motor axons. (C) After successful nerve regeneration and elective amputation, the patient′s attempt to make a fist produced a reliable EMG signal detectable with transcutaneous electrodes placed over the muscle. (D) To improve future prosthetic handling and avoid excess length of the prosthetic limb, a humerus shortening osteotomy was performed upon amputation in the same patient.