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MEDICAL MARVEL: MISSING THUMB RECONSTRUCTED BY TOE TRANSFER FROM FOOT
India
healthysoch
New Delhi, January 26, 2023:
Sir Ganga Ram Hospital received a 44yr old male from Uttrakhand in the emergency on 7/1/23 who suffered total amputation of 3 fingers & one thumb including left thumb, index, middle and ring finger due to industrial injury in a factory in Uttrakhand. Patient arrived at Sir Ganga ram hospital in the evening around 8 hrs after injury, bleeding profusely bringing the severed 3 fingers in a polythene bag but the thumb was not present in the bag.
According to Dr. Mahesh Mangal, Chairman, Department of Plastic & Cosmetic Surgery, Sir Ganga Ram Hospital, “The challenge for us was not only to rejoin the three crushed fingers back to hand but the biggest challenge was to reconstruct the missing thumb. For this we decided thumb reconstruction by 2nd toe transfer from right foot of the patient to make his hand fully functional.”
For this a team was formed under Dr. Mahesh Mangal which consisted of Dr. S.S. Gambhir, Dr. Nikhil Jhunjhunwala and Dr. Pooja Gupta from the Department of Plastic and Reconstructive surgery, and Dr. Manish Dhawan from the Department of Orthopaedics.
Patient was immediately shifted to OT and after 10 hours long microsurgery all the three fingers were reimplanted (rejoined) by joining the blood vessel, nerve, bones and tendons under microscope. Since the thumb was not brought, thumb reconstruction was planned by 2nd toe transfer from right foot to make his hand fully functional.
Microsurgery was started in 1981 in The Department of Plastic surgery at Sir Ganga Ram Hospital, Delhi. Dr. Mahesh Mangal, Chairman, Department of Plastic surgery, says since then the department has grown to become a center of excellence in Reimplantation of cut body parts due to industrial, agricultural, household, road traffic accidents, etc. We have done more than 500 reimplants of different body parts like fingers, toes, penis, scalp, ear, upper limb, etc. Dr. Mahesh Mangal would like to emphasize the importance of bringing the amputated parts, patients and relatives should always try and search for the amputated part at the trauma scene. Timely, efficient transportation of the patient and the preserved amputated part to the reimplantation center is critical for survival and function.
For this the amputed part has to be washed and cleaned. Then it has to be put in a clean polythene bag. This first bag after tightening has to be transferred in the second polythene bag filled with ice. Extreme care needs to be taken that the amputed part does not get in touch with ice. Then the patient along with the polythene bags needs to be transferred to a bigger hospital where microsurgical plastic surgery techniques are available
Surprisingly, we had two more patients in the same week, all of them in different age groups and at different levels of amputation with different mode of trauma.
Patient 2- 10yr old boy presented to the emergency with crush amputation of right middle finger at the distal level, brought in a polythene bag from a village in Rajasthan, he sustained the injury while playing, by a wood cutting machine. Since the level of amputation was very distal and the patient was a child, the blood vessels which needed to be joined were very fine which required supermicrosurgery and very fine suture material to rejoin his finger. This was done successfully.
Patient 3- 20yr old male from Noida, presented with amputation of right index finger with no vascularity. He suffered household injury due to accidental fall of washbasin while cleaning and came to the emergency at midnight. After 6 hours of microsurgery his finger was rejoined.
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