When Amputation is the Best Form of Salvage:
An Interview with Matt Carty, MD
Q: In 2014, you won a Stepping Strong Innovator Award for your idea of revolutionizing the way we do lower extremity amputations. Just two years later, you performed the first clinical representation of your work on Jim Ewing. How many patients have undergone the Ewing Procedure?
A: To date, we have performed the procedure on six patients, including Jim and Army veteran Brandon Korona, whose leg was damaged by an improvised explosive device in Afghanistan. One more patient was recently scheduled, and two additional patients are being screened.
Q: What kinds of patients qualify for screening?
A: We consider patients who suffer from a spectrum of injuries—from traumatic injuries to congenital abnormalities to failed reconstructive procedures to autoimmune conditions. We also seek to support interventions for military personnel injured in combat.
Q: Why would a patient elect to have an amputation?
A: For patients with a high level of chronic pain, amputation can be the best form of salvage. Those who have undergone the procedure report an improved quality of life—they retain more muscle, have less phantom pain, enjoy more precise control of their limb, and increased sensory freedom.
Q: You collaborated with experts from the MIT media lab to develop the procedure. Tell us more about this partnership.
A: Broadly speaking, it is always more powerful to collaborate than to work in silos. Our specific partnership unites our clinical work with a discipline called biomechantronics—a systems-based approach that informs the design of the procedure by integrating biology, mechanics, and electronics. One of the best aspects of our collaboration is that the development of the biomechantronics informs the clinical work, and the clinical side informs the creation of the biomechantronics—so, together, we continuously modify and improve the procedure.
"We recently received a $3 million grant from the Department of Defense (DoD), which will hopefully allow us to move forward with human clinical trials and disseminate our findings to the rest of the world."
Q: Can you explain how the biomechatronics work?
A: Our colleagues at MIT, led by Hugh Herr, PhD, are developing a special prosthetic limb that can link with the modified amputations we’re performing to offer these patients a level of function that is much greater than we’ve seen in the past. This prosthesis interfaces with the body through special electrodes that sit on or under the skin, and are able to transmit information back and forth between the device and the patient.
Q: What are the next steps for this experimental procedure?
A: We recently received a $3 million grant from the Department of Defense (DoD), which will hopefully allow us to move forward with human clinical trials and disseminate our findings to the rest of the world. We are cautiously optimistic. Several papers are in the works and we have recently been asked to present our early findings at a number of professional conferences both nationally and internationally. Finally, the DoD invited us to submit an identical grant with a goal of applying the procedure to upper limbs. We should hear back about this grant any day now.
Q: Congratulations on your accomplishments!
A: This has truly been a team effort. I am fortunate to do such gratifying work on a day-to-day basis, and I’m extremely thankful to Stepping Strong for providing the seed funding that helped take our research from the lab to the operating room in such a short time.