Burned, blasted, and crushed hands can make things more complicated. In some cases where the thumb was cut clean off, all of the necessary vessels are accessible to the surgeon. Talbot noted that there isn't an easy analogy that explains the difficulty of the procedure, but said, "It is like sewing together a chopped chive with a human hair, but keeping in mind that the goal is to keep an open central lumen while ensuring that the juncture is water-tight."Īnd since many patients lost their thumbs due to trauma, the tissue that surgeons need to reconnect may not be easy to “hook up,” as Rosen phrases it. Making a cut a few millimeters in one direction versus another can alter the overall function of the digit, emphasizing the importance of where you position the thumb in space with respect to the patient’s hand.” “Fine details, such as how you angle your cuts on the bone, can impact the overall function of the thumb. Alexander Spiess, division chief of hand surgery for the University of Pittsburgh Department of Plastic Surgery, said. “There are many moving parts, when it comes to performing procedures as intricate as a toe-to-thumb transfer,” Dr. Simon Talbot, said the procedure “may be pinnacle of microsurgery for a microsurgeon.” Surgeons must connect the muscles used to flex and extend the thumb to those that flex and extend the great toe, respectively, and attach at least two nerves so that feeling from the toe communicates with the former thumb’s nerve.ĭirector of upper extremity transplant at Brigham Women’s Hospital, Dr. Once they have the toe off and the hand prepped, the transfer requires the use of microscopes to reattach the delicate corresponding nerves, vessels, tendons, and skin. Though sometimes surgeons transfer the second toe, typically they opt to use the great toe. It requires two surgical teams-one that harvests the toe and another that prepares the hand for transfer.
Įven with a minimum of four surgeons in the room, the procedure takes about eight hours. He was hesitant at first but trusted his surgeon, Dr. He had heard of finger transfers and figured this transfer was typical. “I took the procedure for granted,” he said. Colello didn’t know that until his thoe generated buzz from local reporters and hospital employees. Francis Hospital had performed a toe-to-thumb transfer. Colello’s surgery was the first time any doctor at St. The surgery is becoming common, but not every hospital is experienced doing the transplant. Nicoladoni’s patient was left without major nerves, but the doctor showed it could be done. After the patient spent weeks bent over with hand locked to toe, Nicoladoni cut the great toe from the foot and left it attached to the man’s hand, thus creating the world’s first “thoe,” as they are sometimes now called. In 1897 Austrian surgeon Carl Nicoladoni performed the first toe-to-thumb in humans by connecting a man’s hand to his foot at the base of the great toe. The procedure that Colello underwent is far from the first of its kind, and yet a world apart from the early days of thumb replacement. Instead of having your hand to hold something, I had to clamp it. “It was a pain - just things around the house. “It was more or less having to learn how to do everything without it,” Colello said about his time without a thumb. Francis Hospital in Hartford, Connecticut. He spent about six months without a thumb before undergoing the a toe-to-thumb at St. Taking someone’s toe and placing it on his or her hand might sound like fiction, but it is an example of a common surgical principle: Replace like with like.Ĭonnecticut hairdresser Philip Colello lost his thumb in September 2013 when cutting wood on a table saw. There is no extra thumb on the human body, so plastic surgeons have had to look elsewhere, and their hunt has taken them south, to a procedure called a toe-to-thumb transfer, which is exactly what it sounds like. Joseph Rosen, a surgeon at Dartmouth-Hitchcock Medical Center. “The thumb is sort of what makes us human because it gives one of our key human functions, which is opposition,” said Dr. It’s an all-important finger, and its functionality determines the ease by which we live our lives. The thumb comprises up to 50 percent of our hand function, depending on the person and the doctor you ask. People who lose thumbs lose a digit that is key to opening doorknobs, grasping pencils, and picking up change. But sometimes, there is no easy replacement for a missing piece and no matching section of skin. They close cleft lips and reconstruct damaged faces using pieces of the body still intact. They also restore the form and function of the body, pulling skin from one place to repair injury in another. Yes, they tuck tummies and build breasts, but it would be overly simplistic to think that’s all they do. Plastic surgeons are masters of rearrangement.
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