A team of Bhutanese and German surgeons has successfully performed the country’s first-ever toe-to-thumb reconstructive surgery. It restored the hand function of a 24-year-old man who had lost three fingers in a workplace accident.
24-year-old Karma Sonam Wangda, working for a private company had sustained an amputation of his right thumb, index, and middle fingers of his right hand which is considered the dominant hand. The accident occurred when he was working with a planner machine two weeks ago.
Yesterday, surgeons removed the patient’s left second toe and transplanted it to replace his right thumb. This procedure was done to restore the thumb, the most vital finger for hand movement and daily tasks.
“Accidentally, the planner machine cut off his three fingers and all the distal part of the fingers were crushed at multiple levels, and it was beyond replantation. So, in such cases, the best thing that we could offer is the toe transfer. Being a first case, it took us some time to convince him, but once we got the consent, we were able to perform it successfully,” said Dr Sonam Jamtsho, Plastic, Burns and Reconstructive Surgeon, Department of Surgery, JDWNRH.
“As you compare your thumb to the other fingers, you will see that the joint architecture in the thumb is completely different to the other fingers. The other fingers just can go in one direction. The thumb can go in this direction, but he can also rotate around himself. And so it is possible to bring the thumb to the little finger, to the ring finger, to the middle finger and to the index. And that’s why the thumb is so important for us,” said Dr Heinz Homann, Plastic and Reconstructive Surgeon, Germany.
According to doctors, removing the second toe has little effect on the foot and doesn’t change a person’s ability to walk, run or jump.
“The reason why we decided to take the second toe for replacement of the thumb is because, as a second toe, it doesn’t have much of a function. The only function is to move, ambulate, and walk, whereas a thumb has a lot of functions. Without the thumb, even the other four fingers are not as functional,” said Dr Sonam Jamtsho, Plastic, Burns and Reconstructive Surgeon, Department of Surgery, JDWNRH.
The surgery lasted around seven hours. It involved connecting tiny blood vessels and nerves to restore movement and feeling. The Bhutanese surgical team collaborated closely with the visiting German specialists to perform the complex procedure.
“This guy is 24 years old, and for the rest of his life, it would be very, very bad to have no thumb or have a prosthesis. There are some prostheses, but they are not comparable to what he has now with his own tissue. And hopefully we did suture the nerves also so that he has sensibility in his new thumb,” said Dr Heinz Homann, Plastic and Reconstructive Surgeon, Germany.
The patient, who is recovering well, expressed gratitude to the medical team. Doctors say it will take around three to six months for him to heal and adjust to the new thumb fully.
Samten Dolkar
Edited by Sonam Pem
