In Norfolk, Virginia, surgeons at Sentara Norfolk General Hospital recently completed a rare procedure: a patient who lost his thumb opted to have it replaced with one of his toes.
The incident was quite serious, with the patient injuring his thumb after a large metal beam fell on it. Dr. Manas Nigam, a plastic surgeon at Sentara Health, explained that they initially tried to salvage the thumb. However, despite their efforts to reconnect the bones, nerves, and tendons, the injury was too severe. “When you’ve got some blood flow in parts but the rest is crushed, there’s just too much damage overall,” Dr. Nigam noted. Although they considered a prosthetic, the patient ultimately decided against that option, feeling it might not suit his needs.
For a more enduring solution, he chose to use his second toe for the replacement. Dr. Nigam, who has experience with similar surgeries from his training, found himself performing this intricate operation as a personal challenge.
Thumbs are particularly complex fingers, capable of moving in various ways unlike other digits. “You’re essentially trying to transfer one bone and heal it to another,” Dr. Nigam said. The procedure involved ensuring the thumb would have its own blood supply, making the connection with the patient’s anatomy crucial. This aspect was especially fascinating for him, as it allowed the thumb to grow into the body naturally. He even managed to weave the tendons to enhance their strength. Reflecting on the surgery’s complexities, he remarked, “A decision made in just a couple of minutes can impact someone’s life forever.” The operation lasted around nine hours, and Dr. Nigam commended his surgical team for their performance, particularly recognizing Dr. Colin McNamara and Dr. Max Wagner for their contributions.
Now, four weeks post-surgery, Dr. Nigam is unsure how the patient is adjusting to the changes. “Once we get full weight on it, we’ll really see, ‘Oh, this is my thumb!’” he mused. The stitches on the foot are expected to be removed in about four to six weeks, allowing the patient to bear weight on it. In the meantime, they have been initiating intensive therapy, and early indicators of movement in the new thumb are promising.
