Of arms and men: losing a limb in Iraq leads a Durham industrial designer on a quest to help amputees get a better grip on things.

• Author: Boykin, Sam
• Position: FEATURE - Company overview

Capt. Jonathan Kuniholm crouches, low and quiet, as he and three dozen other Marines advance through a thick palm grove along the Euphrates River. The platoon is looking for Iraqi insurgents who a few hours earlier had fired at a boat patrolling near Haditha Dam. As they close in on the suspected hot spot, a homemade bomb hidden in an olive oil can explodes. Shrapnel rips through the squadron, knocking Kuniholm off his feet. When he regains his senses a few minutes later, he sees his right arm is nearly severed just below the elbow. His M-16 rifle is blown in half. Amid a raging firefight, Kuniholm pulls himself out of danger and is airlifted to the al-Asad air base hospital, near Baghdad. Surgeons have to amputate the lower part of his ravaged arm. It's Jan. 1, 2005. Happy New Year.

A week later, he undergoes surgery at Duke University Hospital in Durham to prepare the injured arm for a prosthesis. A few months later at Walter Reed Army Medical Center in Washington, D.C., doctors outfit him with several artificial limbs, including one with a split-hook gripping device, which operates via a harness and cable system activated by arm movements. He's also given a more cosmetically appealing myoelectric prosthesis, which uses electrodes to translate nerve signals produced by muscle tension in the upper arm into hand movements. Flexing his upper arm causes the hand to grip; relaxing causes it to release.

He finds both frustrating. The myoelectric limb is heavy and slow-operating. The wrist motor isn't strong enough to turn a doorknob. The piratical split hook works better, but it's a poor replacement for a hand, and the basic design hasn't changed much since World War I. "This sucks," Kuniholm thinks. "I could come up with way better ideas than this." He has reasons to believe that. His tour in Iraq has interrupted his quest for a doctorate in biomedical engineering, and he and some guys from his master's program had started an industrial-design consultancy in Durham--Tackle Design Inc. But he quickly discovers that lack of ideas isn't why progress on prosthetic hands has been so slow. Patent literature is full of promising ideas that never become products.

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The problem, it turned out, lay in the market. It's too small for companies to justify spending much on research and development. About 2 million Americans--less than 1% of the population--have lost a limb to illness or trauma, and only a fraction of them need hands. "There are like 75,000 potential customers for our prosthetics in the entire United States--less than half of Durham," Kuniholm says. "Probably half of them are right[-handed] and half of them are left, and there are all different levels and all different preferences. By the time you segment that down to a single product, you're talking about a roomful of people."

Tackle Design had never focused on making lots of money. It started with a client base consisting largely of what Kuniholm calls "crazy inventors," who were long on dreams and short on cash. The partners operated more like a confederation of contractors than a buttoned-down business. Doing interesting work mattered more than raking in revenue. Marginally profitable, the company grossed less than $1 million a year.

His partners helped Kuniholm develop a strategy for making better artificial hands with meager financial resources, and the company is close to bringing products to...