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Jun Nagase

Book on Biotechnologic Surgery

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Welcome to the UCFMIMDCS book on Biotechnological Limb Surgery

United Citizens Federation Mobile Infantry Medical Department Center and School

UCFMIMDCS-Biotech.jpg

This book will cover in full the various procedures necessary to outfit a Trooper with biotech limbs of all kinds.

 

                                                                                                                                                                                                                                         

Page 1

Foreword

This book is provided by the United Citizens Federation Mobile Infantry Medical Department Center and School for the purposes of teaching Field Medics and Orderlies in the field of Biotechnological Limb (BT) attachment surgery for both surgeons and surgeons assistants.

 

While this book will cover Biotechnological Surgeries, hereforth reffered to as BT Surgeries, ranging from common to rare, certain special occasions may arise that  this book does not cover. In the event of a special occasion BT surgery you are uncertain of that this book does not cover, refer to a more seasoned surgeon for advice.

 

Author: Mary Hamilton

 

Legend

Page 1 - Foreword, Legend

Page 2 - Pre-Operation

Page 3 - Biotech Limb Attachment Surgery

Page 4 - Post-Operation

Page 5 - Biotech Limb Rehabilitation Exercises

Page 6 - Repairs, Battery Repair, Recharge Unit Repair

Page 7, 8 - Servo Repair, Nerve Cluster Housing and Computer Repair

Page 8 - Biotech Eye Surgery Part One

Page 9 - Biotech Eye Surgery Part Two

Page 10 - Biotech Eye Rehabilitation Exercises

Page 11 - Biotech Eye Repairs and Cleaning

                                                                                                                                                                                                                                         

Page 2

Pre-Operation

 

General Pre-Operation Procedures

 

Before beginning the surgery, these things should be taken into account for all surgeries, regardless of the type of BT.

 

  • Ensure Biotech is delivered to the surgery room and packaging is undamaged. Damaged packaging may lead to contaminants on the BT entering the bloodstream
  • Check patient records for allergies and previous medical records that may apply, ask in person in case of incomplete records
  • Ensure all required equipment is available and properly sterile in the surgery room, including general anaesthesia gas tank being adequately filled
  • Ensure surgery room is properly sterilized
  • Ensure crew is aware of surgery taking place to prevent walk-ins, causing possible contaminants and subsequent complications with the surgery
  • Ensure recording camera is turned on for the duration of the surgery
  • When starting the operation, ensure door is locked and all participants are wearing scrubs, nitrile gloves, hair nets and surgical masks
  • Place oxygen mask located on the side of the surgery table ontop of the patients face
  • Attach vitals monitors to the patient
  • Ensure oxygen mask is properly fitted over the patients face and turn on general anaesthesia gas flow
  • Ask patient to count down from ten to assertain when they go unconscious
  • Ensure patient is properly unconscious and hooked up to vitals monitors before proceeding with the surgery
  • Ensure incision area(s) are shaved with an electric razor

 

Failure to complete any item on this list could lead to severe complications and even patient fatality. (except the recording camera.)

 

                                                                                                                                                                                                                                         

Page 3

 

Biotech Limb Attachment Surgery

 

This segment will cover a common biotech surgery.

Limbs are frequently lost in the Mobile Infantry, as such this is one of the relatively common surgeries you will face in your medical career in the Mobile Infantry.

 

  • Ensure patient is properly unconscious
  • Mark incision points on the stub with dotted lines using surgical marker
  • Sterilize incision areas with antiseptic skin agent (generally applied with a cotton piece)
  • Make initial incisions along dotted lines
  • Peel back skin and hold in place using small strips of surgical tape
  • Isolate open blood vessels and cauterize as necessary
  • Isolate and remove any remaining unnecessary bones, ligaments and tendons (any below the ulna and radius in the case of hand BT surgery for example)
  • Isolate tendons and ligaments in the open stump, hold out with clamps
  • Carefully isolate nerve clusters in the open stump, keep in control with small clamps
  • Drill into the side of the bone for attachment (radius in the case of a hand replacement), two ontop and two on the underside, ensure they are in their correct position by placing the BT baseplate on the bone and drilling through premade holes on the plate
  • Ensure proper fit for the BT baseplate and secure with screws
  • Remove clamps and attach ligaments and tendons to the BT baseplate on their respective positions as marked on the plate itself
  • Carefully assign nerves into the BT plate nerve center, this procedure takes by far the longest
  • Once complete, ensure all nerves are safely held in position and close the BT plate nerve center
  • Remove tape from the skin and place the skin over the BT nerve cluster, ensure a seal between the BT bone attachment point and the visible part of the BT. No parts of the plate where nerves, tendons and ligaments attach must be visible when closed, graft skin if necessary
  • Stitch incisions, flush with saline and wipe with sterile wipes
  • Attach BT limb to the baseplate attachment point, ensure proper attachment to the attachment point
  • Once fit is confirmed, remove BT limb and bandage stump
  • Transport patient back to their original room and continue to monitor vitals, await patient awakening
  • Once patient is awake and aware, remove bandages and reattach BT limb, ask them to move individual 'muscles', such as fingers, toes and the like
  • Most cases will show limited movement at best, this is normal. Ensure each 'muscle' is able to move to confirm nerve cluster is assigned correctly
  • Once functionality is confirmed, explain the learning procedure they must undergo to learn to use their new BT limb. This will be covered on a later page

 

The procedure may vary from BT to BT, though a limb surgery is by far the most common. Eye surgeries however do occur at times when eye damage is beyond repair, or when the eye is entirely missing.

 

                                                                                                                                                                                                                                         

Page 4

 

Post-Operation

 

General Post-Operation Procedures

 

Once the surgery is complete, these things should be taken into account.

 

  • Move the patient to their room, ensure vitals are being monitored
  • Ensure all used disposable equipment is safely disposed of in biowaste bins
  • Ensure surgery room is properly sterilized
  • Ensure all reusable equipment is properly sterilized and stored in their proper locations
  • Ensure recording camera is turned off post-surgery and log video file accordingly
  • Ensure surgery is properly logged in the database along with any possible complications, anomalies or anything generally noteworthy

 

 

                                                                                                                                                                                                                                         

Page 5

 

Biotech Limb Rehabilitation

 

Procedures for teaching Troopers to use their new biotech limb

 

This page will go over the methods used for teaching troopers the best ways to properly learn to use their new limb so that it may mimic their original limb best as it can.

Some people will learn faster than others, so consistency is key.

Some Troopers may have  trouble accepting their new state of being, in which case if you suspect significant trouble coping, you should refer them to a psychologist for evaluation and assistance. Losing a limb is a highly traumatic experience and many Troopers experience depression, sometimes for extended periods of time after losing a limb.

 

  1. Fine Motor Control Exercises

Fine motor control is highly important especially for those with BTs that replace their hands. It's vital to function in the Mobile Infantry to be able to finely manipulate small and delicate objects. This point will cover exercises that teach a Trooper to finely manipulate everyday objects in a safe environment.

 

  1. A. Utensils

Give the trooper who's lost a hand a fork, instruct them first to grab the fork as one would normally, then instruct them to pick up various small items like a small ball, a pen, and eventually food with the fork. Have them eat foods that frequently rely on the use of forks, knives and spoons to get them used to every day fine-motor control. Eating with utensils uses more fine motor control than most realize.

   

      1. B. Eggs

Eggs are small, delicate objects that easily break if dropped or mishandled. Regularly hand a trooper with a new BT hand an egg and tell them to perform various tasks. At first, simply instruct them to pick up the egg without dropping it or cracking the shell. Once they can comfortable pick up an egg, instruct them to place them in specific spots. This will teach them to know how much pressure to exert on an object to pick it up without dropping or squeezing it, and teach them to put it down gently, without releasing too soon.

 

      1. C. Small puzzles.

Give a trooper a puzzle including small pieces. Things like placing a pin inside a neatly fit hole, later putting the thread in a sewing needle et cetera. This will teach them to finely manipulate objects.

 

 

      2. Reaction Speed Exercises

Reaction speed is important for a Trooper. Being able to quickly and properly react to threats is vital for combat roles. These exercises will help a Trooper learn to react properly with their new Biotech limb. This is mostly for Troopers who have full limbs replaced, though just hands need this too.

 

      2. A. Squishy ball

Throw small soft balls at the Trooper and tell them to only react with their new Biotech limb. Instruct them to catch it with their BT hand, or return the ball with a kick from their BT leg. This will teach them to move their limb in accordance with an oncoming object and catch it.

 

      2. B. Throwing balls

Throwing items, mainly soft balls, is a safe way of teaching a Trooper to use their arm effectively to throw objects. By throwing balls into specific areas or passing ball between them and someone else will teach them how to properly manipulate their BT arm and hand to accurately throw objects like grenades or magazines and teach them how to manipulate their BT to release in a timely manner.

 

                                                                                                                                                                                                                                         

Page 6

 

 

Biotech Limb Repairs

 

Biotechnological limbs are frequently damaged by various means, from general wear and tear to misuse to accidental and combat damage. While engineers may be able to fix the simplest damage and superficial damage, it takes someone trained specifically in the intricate functions of a biotechnologic limb to properly and safely restore a damaged biotech to full function.

 

This segment will teach you how to properly and safely repair military-grade biotechnological limbs to full functionality without causing further damage.

Before conducting repairs, please ensure to shut down the BT entirely as to prevent injury.

 

 

Power Source

Your average biotechnological limb is powered by a small, portable and replacable long-lasting battery along with a small motion recharging unit.

 

   Battery

The battery in a biotechnological limb is sized proportional to the size of the BT itself and the required power output for extended combat use. For example, a single finger has a tiny power pack inside it providing enough power to last up to three weeks of constant combat deployment (with the motion recharge unit disabled), providing sufficient power to simulate the strength of a finger. Similarly, a full arm holds a battery in the upper arm capable of sustaining the BT on its own for a similar length of time, providing enough power to simulate a well-trained soldier's strength.

 

For safety reasons, if damage to the battery pack is suspected it must be replaced immediately. Damage to the battery pack could lead to violent combustion and severe damage to the BT and the user.

 

   Motion Recharge Unit

All standard military-issue biotech limbs are fitted with proportionally small motion recharge units, converting the average daily motions into small amounts of power to recharge the battery. While the motion recharge unit itself cannot sustain full power to a BT, the constant daily charge will, in most cases, be sufficient to keep a BT fully charged at the end of the day assuming both recharge unit and battery are in full functioning order.

 

Should you find a motion recharging unit damaged in a biotech, a simple replacement is the simplest fix as the motion recharge units are relatively simple and cheap to replace, often kept in stock wherever BTs are stored and used. Should replacement not be possible, ensuring the unit is not rusty or sticky and is properly oiled can help increase the output. Ensuring no parts of the housing unit is dented, and if it is, fixing said dents, can help fix and increase a damaged or low-output unit, as dents can cause friction inside the unit, reducing its charge.

 

   Alternate power/recharging

All standard military-issue biotech limbs are fitted with some form of recharging socket, depending on size. Plugging the BT into a power source will recharge the battery directly. It is also possible, if necessary, to open up the BT limb and directly wire into the connection between the battery and the motion recharge unit to recharge the battery that way, should a suitable plug not be available, or the BT socket damaged somehow.

If necessary, an alternate battery can also be fitted to the BT, though BTs may have reduced functionality when connected to non-standard batteries. For voltage, please refer to the inside of the respective BT cover.

 

 

 

                                                                                                                                                                                                                                         

Page 7

 

Servos

All biotechs are fitted with servos to function the various daily motions. These are especially prone to wear and tear damage.

In order to repair a damaged servo, replacement is an easy option. Should replacement not be available, please ensure all wiring in the servos are undamaged, ensure circuits are undamaged and clean, ensure motor is undamaged and clean, ensure gears are not rusted, sticky or damaged and is properly cleaned to reduce wear and tear.

Please note that most BTs come with multiple servos per range of motion, both for the sake of strength and for the sake of reliability. If a range of motion is completely disabled, it likely means a main gear connected to the servos is damaged and needs replacement or repair, or the nerve cluster minicomputer is damaged as opposed to a servo being damaged. The exception to this is fingers and toes, which generally only have a single servo functioning their respective range of motions.

 

Nerve Cluster Computer/Nerve Cluster Housing Unit

All biotechs are fitted with small computers used to decode nerve signals from the nerve cluster housing unit and transform them into usable signals for the BTs various functions, primarily servos.

In order to repair a nerve cluster computer, the easiest option is simple replacement. Please note that in some rare instances, the computer may have been adjusted for the specific person. If replacement is not available, attempt to identify which part of the computer is damaged;

  • CPU
  • Motherboard
  • Power Unit
  • Circuitry
  • Data Storage Unit

 

   CPU

If the CPU is damaged, there is no option but replacement as the CPU is likely too small and intricate to be repaired outside of a dedicated BT parts repair shop.

 

   Motherboard

If the motherboard is damaged, there is also no option but replacement.

 

   Power Unit

If the power unit is damaged, it is highly recommended to replace the unit. If replacement is not possible and function is necessary, it -is- possible, though not recommended, to try to create a small power unit from spare parts to replace the damaged one, usually done so with assistance from an engineer or technician. These power units are made to regulate power output to various parts of the computer. Please refer to the individual parts for power requirements and ensure their needs are met and not exceeded.

 

   Circuitry

If circuitry is damaged, handing off the BT to either a dedicated BT repair shop or if necessary, a skilled engineer or technician, is recommended. It is possible to reciruit damaged parts if necessary.

 

   Data Storage Unit

If a Data Storage Unit is damaged, replacement is required. Ideally this is done with a dedicated BT data storage unit, however should one not be available, it -is- possible to download software onto a repurposed generic data storage unit, such as a solid state drive, and convert it into a functioning unit for the BT.

 

 

                                                                                                                                                                                                                                         

Page 8

 

 

   Nerve Cluster Housing Unit

The nerve cluster housing unit is there to hold the nerves in place, read nerve signals and transmit them to the nerve cluster computer. If this is damaged, complete replacement is required along with extensive surgery to replace and repair all nerves connected.

 

 

Biotechnological Eye Replacement Surgery

 

As happens, eyes are damaged beyond repair in the field and in accidents. To our luck, our brightest have created biotechnological eyes to fix this type of damage.

However, for standard combat deployments, these eyes function with little difference from a natural eye, but with a lack of sensation. As such, a person with a BT eye will no longer feel pain or discomfort in the BT eye when exposed to bright light, even as far as flashbangs will not produce discomfort. It will still however overload the optic and temporarily blind the eye, as it would a normal eye.

 

Due to rehabilitation time and power limits, BT eyes cannot perform things like nightvision, thermal vision, zoom or even light emmission. It would either drain the power too much, and/or take too long for the brain to learn to use to be a useful edition to the standard military biotech eye.

 

Pre-Operation

For eye surgery, a sterile environment is especially important as the surgery will be dealing with a direct connection to the brain, and any foreign objects could cause severe complications and fatality in the patient. Otherwise, same procedure as standard Pre-Op applies.

 

Operation, Part One

Part one of the operation consists of establishing the base computer on the end of the optic nerve and inserting the battery and motion recharge units.

 

  • Open empty eye socket and sterilize inside
  • Remove any unnecessary leftovers via scalpel (no natural eye muscles will be necessary, optic nerve should not extend beyond 2 centimeters from its entry point to the brain)
  • Insert nerve cluster housing unit into the eye and secure, begin assigning nerves from the optic nerve into the nerve cluster (this takes a very long time, sharing this step with a second senior medical person is recommended)
  • Once nerve cluster has been assigned and confirmed, unsecure the nerve cluster housing unit and place into the optic nerves entrance to the brain, then carefully secure with small drills into the premade screw holes, then secure with screws
  • Attach the nerve cluster computer to the end of the nerve cluster housing unit, ensure proper fit
  • Attach battery pack to the side of the inside at 45 degrees clockwise or counterclockwise depending on which eye is being replaced, by means of drill and screws (battery pack should be fitted towards the outside of the head, ie if replacing patients left eye, attach battery at 45 degree clockwise from surgeons perspective)
  • Attach motion recharging units to the side of the battery pack, ensure proper fit and connection
  • Connect battery pack with nerve cluster computer and ensure it is powered (small green LED)

 

 

                                                                                                                                                                                                                                         

Page 9

 

 

Operation, Part Two

Part two of the operation cosists of attaching the eye muscles to the nerve cluster computer and anchor points, then finally attaching the BT eye to the nerve cluster computer and the muscles to the eye. Because relearning is a lengthy process, the muscles have been made to mimic the eyes natural muscles, as such please refer to the image below the steps.

 

  • Attach both lateral rectus muscles to the nerve cluster computer and their anchor points (refer to nerve cluster computers connection points, LLR and RLR (left and right lateral rectus), refer to anchor points on nerve cluster housing unit with same designations)
  • Clamp ends of both lateral rectus muscles and keep out of the way, muscles will be long and flaccid until powered on, allowing them to hang out of the eye socket
  • Repeat with inferior rectus muscle
  • Attach inferior oblique muscle, secure anchor point by drilling into the maxilla and securing with screw
  • Remove trochlea and replace with artificial trochlea attached to the superior oblique muscle, secure with drill and subsequent screw
  • Attach superior oblique muscle to nerve cluster computer and housing unit anchor points, clamp out of the way
  • Repeat with superior rectus muscle
  • Turn on nerve cluster computer
  • Insert biotech eye's connection to the nerve cluster computer
  • Connect biotech eye to battery and ensure it is powered
  • Insert muscles into their anchor points, refer to anchor point labels on the biotech eye
  • Fully insert the biotech eye, roll eye up 90 degrees and press a small button next to the inferior rectus anchor point on the eye itself, return eye to neutral position
  • In ~10 seconds, muscles should come to life and keep the eye in place inside its socket

 

 

 

Extrinsic muscles of the eye.jpg

 

 

                                                                                                                                                                                                                                         

Page 10

 

Biotech Eye Rehabilitation

 

To train a Trooper to use their new biotech eye, task them with fairly standard eye exercises.

Since single eye biotechs are most common, patients will be unable to use both eyes at once as the brain has not learned to coordinate them together yet. Place an eyepatch over the other eye while early rehabilitation exercises take place. During early stages, an eyepatch must be worn over the biotech eye while moving around to prevent confusion in the patient as they will struggle to coordinate their movements with an eye that does not yet function to their expectations.

Later, eye coordination is trained and eyepatches will no longer be necessary.

 

 

Single eye exercises

 

  • Point to point

Task a trooper with looking from one point to another while keeping their head still. A simple task that will teach their brain how much input to give on the muscles to efficiently look between points in the world.

Later, ask them to look from point to point while turning their head slightly as well, this will teach the brain to be able to look to points efficiently while moving.

 

  • Tracking

Task a trooper with tracking objects. At first, something simple like a pen, then task them to follow your face as you pace around. Later task them with tracking more erratic motions, such as a TV show. Finally, throw balls at them and ask them to catch it. These will teach them to effectively track objects and use the information to coordinate their bodys movement.

Ask them to keep their eyes on a single point while rotating their head, effectively tracking while on the move.

 

  • Reading

Task a trooper with reading once they're capable of some level of tracking and point to point movement. Generally books are preferred, though subtitles are also effective.

 

 

Double eye exercises

 

  • Point to point

Task a trooper with looking between points with both eyes, essentially the same as with single eye exercises. This time, it will teach the brain to coordinate the movement between both eyes so they do not give conflicting information.

 

  • Tracking

Task a trooper with similar tracking exercises as the single eye exercises, this will teach their brain to coordinate their eyes to track objects.

 

  • Reading

Task a trooper with reading with both eyes once some level of dual-eye tracking and point to point movement has established.

 

 

                                                                                                                                                                                                                                         

Page 11

 

Biotech Eye Repairs and Cleaning

 

In order to repair components of a biotech eye, the eye itself must first be removed from its socket and its anchors.

To do this, relax the eye muscles by rotating the eye upwards 90 degrees and pressing the small button next to the inferior rectus muscle's anchor point.

In ~10 seconds the muscles should relax, allowing the eye to come out of its socket.

In the event of power failure to the eye, the muscles will automatically relax when power is cut, and no optical signal will be sent from the eye.

 

For battery and motion recharge units, as well as nerve cluster housing and computers, same applies as in standard BTs described on page 6.

 

Biotech Eye Repair

In order to repair the eye itself, remove the eye completely from its socket and any connections and anchors to the inside of the eye.

Carefully unscrew the four screws on the back of the eye and take off the piece gently, then remove all connections from the back plate of the eye to allow full removal.

Once removed, access to the inside of the biotech eye is available.

 

Most pieces inside the eye itself will require replacements in order to be functional again, with the exception of dirt within the eye.

Carefully remove layer after layer of components to clean them effectively. Usually dirt inside the eye is recognized by the eye struggling or being outright unable to refocus on objects at a certain distance (dirt preventing gears from properly rotating), or by strange mixed signals usually recognized by struggling to make sense of what the eye sees (dirt or loose connection to the optic nerve)

 

Should it be necessary, the gears and optic itself can be replaced by non-standard equipment in emergency situations, however full functionality or safety to the wearer is not guarenteed.

Before the eye is reinserted, it is highly recommended the eye is sterilized to prevent infections.

 

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