Monday, 8/4/97 Toe-to-finger surgery gives new mobility
TRANSPLANT: Hand Center’s physician reconstructs digits, lives in
miracle procedure
By Dawnya Pring Daily Bruin Contributor Imagine using thread
thinner than a human hair to sew 10 sutures – in a nerve with a
diameter as thick as a penny. This is exactly what surgeon Dr. Neil
Jones does for patients missing a finger through birth defects or
accidents. Removing a toe (usually the big toe or second toe) from
a patient’s foot, he surgically attaches it to the hand. The toe is
then transformed into a finger. "It’s like a plumber connecting two
pipes," says Jones, director of the UCLA Hand Center. His own hands
twist and rise, attempting to describe his complex toe-to-hand
micro-surgeries in laymen’s terms. "We have to connect one pipe
which is the artery in the toe, to the pipe in the hand, the vein."
It’s much more than plumbing as Rosemary Sanson, mother of
four-year-old Ashley Sanson, one of Dr. Jones’ recent patients,
will attest. "It has been a miracle for Ashley. She can play
Barbies, pick up a glass of milk with her left hand," Sanson said.
"She takes two cookies now, one in each hand, and will keep one and
give the other to her sister." Ashley was born with a congenial
anomaly, a birth defect that occurs in two of every 15,000 births.
This left her with only a thumb and four "buds," as the Sansons
call them. "Buds," known in the medical community as nubbins, are
little fingers that are about half the size of a normal finger.
They do not have knuckles or cartilage, but often do have
fingernails. Ashley loves to paint her fingernails. What exactly is
a toe-to-hand transfer? According to Dr. Jones, it is the epitome
of a technique known as a ‘free tissue transfer,’ a subspecialty of
micro-surgery. The first free tissue transfers were attempted in
the late ’70s. Surgeons took a piece of muscle or skin from one
area of the patient’s body and united it with another area of their
body in need. A toe-to-hand transfer has taken this principal and
expanded upon it. According to Jones, a toe usually won’t be
missed, because its removal doesn’t affect the foot’s balance.
However, a missing finger can greatly affect a person’s life. The
big toe is used as a thumb replacement because of its relatively
similar size, and the second toe is used to replace a finger. "We
try and make the toes look like fingers," Jones said. The staff
takes measurements from the normal thumb and looks at its length,
circumference, and the width of the nail. They then transfer those
measurements onto the big toe. They leave the tissue that they
don’t need on the foot and transfer the toe. Now, the transplanted
toe will be approximately the same size as the other thumb. But
that’s the easy part. With a microscope, the surgeon fastidiously
works using miniature tools developed by jewelers, often spending
up to 12 hours in surgery. The bone from the toe must be connected
to the bone left at the base of the finger. Then the tendons and
nerves from both appendages are mended together. Finally the
arteries and veins are sewn together. It is imperative to the
success of the surgery that the blood flow freely, uninhibited
through the new passages. It is the flowing blood that keeps the
finger alive. Although the foot-to-hand surgeries are gaining in
fame, they are still not known by all in the medical community, as
Sanson learned after she gave birth to Ashley. "My obstetrician
didn’t know what to say to me, all he could say was that he had
never seen anything like this," Rosemary said. What Rosemary
learned about her daughter’s condition and the possible treatments
were the results of a relentless pursuit of information. "I was
lucky. I sort of stumbled upon Dr. J.," as Rosemary affectionately
calls Dr. Jones. She also jokingly says that he can walk on water.
Finally Rosemary had a breakthrough. A doctor she was in contact
with had taken a tour of UCLA’s medical facilities and had learned
about the innovative procedures taking place at the hand center.
"This is right at the limits of surgery," says Dr. Jones, "but the
benefits to the patient are enormous." In many cases, the
difference between having and not having the surgery is the ability
to have a fulfilled life. One of the hand center’s patients was a
man who operates heavy machinery, who lost his thumb in a workplace
accident. Since the thumb is responsible for 40 percent of the
hands’ functional capabilities, the accident drastically reduced
the quality of his life. He could no longer work, which left him
feeling unproductive and depressed. After a successful surgery, a
practically new man emerged. He was able to return to work in eight
weeks. Free tissue transfer, according to Dr. Jones, is "ready to
go" for the future. The techniques are already in place to attach
foreign organs to different bodies. Although not dissimilar to
heart or liver transplants, free tissue transfers deal with hands,
arms, and legs. Dr. Jones believes that someday, just as doctors do
liver transplants, they will be able to do an arm transplant. The
biggest obstacle is in the field of immunology, where the
understanding of organ rejection needs to be advanced. Since the
body tends to reject new organs, the risk to the patient is still
too great for non-life-threatening surgeries. Dr. Jones believes
that … just as doctors do liver transplants, they will be able to
do an arm transplant. ALEKSEY KOMPANIYCHENKO Look closely: that’s
not really a thumb. Dr. Neil Jones makes toes into functional
fingers at the UCLA Hand Center. ALEKSEY KOMPANIYCHENKO Dr. Neil
Jones Related Link Clinical Cases