Surgeon replaces patient's lost thumb with toe
NORFOLK, Va. (WAVY) — A surgeon at Sentara Norfolk General hospital in Virginia recently performed an unusual and very rare procedure. A patient lost a thumb — and decided to replace it with one of his toes.
It was an accident that could have jeopardized the patient's career.
"He had a big metal beam or sheet that fell on his thumb and basically amputated it.” Dr. Manas Nigam, a plastic surgeon with Sentara Health said.
Saving the thumb was the initial goal, but while they tried to reattach the bones, nerves, and tendons the damage was so bad, it was impossible.
“If you get blood flow to one part of it, the rest of it is crushed, there's just too much 'zone of injury' to the entire part,” Dr. Nigam said.
They discussed replacing it with a prosthetic, which the patient later decided against.
"You have to take it off and on, and sometimes you need different kinds of prosthetics depending on the type of task at hand."
For a more permanent solution, the patient decided to replace the thumb with a toe. His second toe, to be precise. Dr. Nigam, who had done a hand fellowship, had performed a similar procedure in his training, but this time it was his own patient.
The thumb is the most complex of all fingers because it can move in so many more ways than the others.
"You're transferring one bone to another bone to try to get them to heal together. But we hooked up an artery in advance, so it comes with its own blood supply. So, it's trying to grow into the body as much as the body is trying to grow into it, which is kind of cool,” Nigam said.
"But your thumb has flexion, extension at the joints, opposition. Not just hooking up the nerves and the arteries and the veins, but actually setting the bone in the right spot, which is interesting.”
He was also able to weave the tendons in a special way to make the tension a bit tighter and stronger. Dr. Nigam still can't get over the details he had to consider during surgery.
“You know, a decision you're making in two minutes that could affect somebody for the rest of their life,” Nigam said.
The surgery took nine hours and went without a hitch. Dr. Nigam praised his team for how well the surgery went, including Dr. Colin McNamara with the Portsmouth Naval Center, and Dr. Max Wagner who was chief resident on the case.
This Thursday will be four weeks post-op. Nigam says he's not sure the patient has really processed the change yet.
"I think that once we get a full weight bearing, I think that'll be a big, big step in the right direction to helping him see, like, 'oh, this is my thumb!"
Stitches will come out of the foot in four to six weeks, then the patient will be able to put full weight on it. In the meantime, they are starting the patient on aggressive therapy and the movement so far in the new thumb is looking good.