Giuliano Vanghetti and the innovation of “cineplastic operations”

OBJECTIVE: Developing functional artificial limbs for amputees has been a centuries-old challenge in medicine. We review the mechanical and neurologic principles of “cineplastic operations” and “plastic motors” used to restore movements in prostheses, with special attention to the work of Giuliano Vanghetti. METHODS: We evaluated original publications describing cineplastic operations, biographic information, writings, drawings, and unpublished letters from the Vanghetti library, preserved in Empoli, Italy, and performed a bibliographic search and comparison for similar procedures in the literature. RESULTS: Vanghetti's method for cineplastic operations differs from similar previous methods, being the first aimed at exploiting natural movements of the remnant muscles to activate the mechanical prosthesis, and the first to do so by directly connecting the prosthesis to the residual muscles and tendons. This represented a frame-changing innovation for that time and paved the way for current neuroprosthetic approaches. The first description of the method was published in 1898 and human studies started in 1900. The results of these studies were presented in 1905 and published in 1906 in Plastic and Kinematic Prosthesis. A German surgeon, Ferdinand Sauerbruch, often acknowledged as the inventor of the method, published his first results in 1915. CONCLUSIONS: Vanghetti was the first to accurately perform and describe cineplastic operations for patients following an upper arm amputation. He considered the neurologic implications of the problem and, perhaps in an effort to provide more appropriate proprioceptive feedback, he intuitively applied the prostheses so that they were functionally activated by the muscles of the proximal stump.