We have seen patients with completely paralysed limbs following serious accidents. After a few years the paralysed limb becomes a burden and patients often find it difficult to carry on even simple activities as the paralysed limb comes in the way.

When the lower limb is involved it is easier to suggest an amputation followed by the fitting of a good prosthesis. Many men and women who have had lower limb prosthesis fitted following an amputation have gone back to normal activities and some of them even indulge in strenuous sporting activities. It is more difficult to suggest an amputation if the upper limb is involved, as a prosthesis for the upper limb should be capable of performing complex and precise function to use the hand.

Surgeons are now attempting to operate on the neuromuscular system of affected patients. The surgery is aimed at generating electrical signals transmitted to the stump which in turn can be picked up to operate a bionic limb. The patient then has to work hard with the physiotherapist for a prolonged period to achieve the desired results.

In a recent report a man whose arm was paralysed after a motorcycle accident in 2002 chose to have his hand amputated and replaced with a bionic limb that he can control with his mind. He contacted Oskar Aszmann of the Medical University of Vienna after learning of his pioneering surgical technique, and travelled to Austria in 2015.

Over several visits he had his hand amputated and a bionic replacement fitted. He can now open, close and rotate the hand, which responds to electrical signals in the muscles of his forearm. Mr Smith, 51, from Nottingham, said: “It wasn’t a hard decision. My arm was totally paralysed so I had no use of it. It just hung there. I’ve struggled for so long trying to do the most basic things, like take the top off a jar or wire a plug, and now I can do it.”

Mr Aszmann has performed 13 such reconstructions on patients who have lost the use of a hand through traumatic injury to the brachial plexus. On his various trips to Vienna, Mr Smith had a muscle in his arm rerouted so that he could flex his elbow, and his humerus cut, rotated and reset to allow his arm to extend forwards in the correct position. Finally, his left hand was removed ready for the prosthetic device. He said the transformation was almost instant, with function returning to the arm when he travelled to Vienna a final time last year for the prosthetic hand to be fitted. “It all seemed to come together. I went for the fitting and I see my arm physically working. I’d had nothing there and all of a sudden my arm is bending and I could move the hand.” The NHS paid more than £45,000 for the prosthesis and operations.

Mr Aszmann optimises his patients’ ability to control a prosthesis, only amputating once he is certain a patient has the means to steer a bionic hand. “It’s a bit risky from the ethical point of view to amputate without being able to offer them something worthwhile,” he said.

He has also operated on Nicola Wilding, 40, an accountant from Croydon, south London, who suffered a brachial plexus injury in a car accident 18 years ago, losing the use of her right arm. He moved muscles from her leg and chest wall to her arm and transferred a median nerve to improve arm movement. In January she had an elective amputation and a tendon transfer in London. The improvement in her arm movement is such that she is testing a prosthetic hand she can open, close and turn using external cables that move as she moves her arm.

“It’s amazing,” she said. “To be able to hold a tube of toothpaste and undo the lid instead of using my teeth. I’ve not stopped grinning. It’s like rebuilding yourself and coming to the pinnacle of what you’ve always worked for.”

Her UK surgeon, Norbert Kang, from the Royal Free London NHS Foundation Trust, says Ms Wilding is a role model and has competed in triathlons to help fund her treatment. “She’s incredibly motivated,” he said. “She deserves everything she can get from whatever we’ve been able to do for her.”