Toe and Knee Bones Used in First Ever Double Flap Hand Surgery

Toe and Knee Bones Used in First Ever Double Flap Hand Surgery

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BALTIMORE—Using a bone from a patient’s knee and a toe from his foot, Drs. James Higgins and Ryan Katz of Curtis National Hand Center, applied a novel and previously unreported approach to rebuild the entire thumb of a 45-year old Glen Burnie man at MedStar Union Memorial Hospital, June 9. The complex microsurgery case used two simultaneous tissue flaps to reconstruct a thumb that was completely amputated in miter saw accident last year.

“I believe his procedure- the double flap surgery- is the solution for patients with particularly severe hand injuries.  Although it is a new level of technical complexity, it offers hope for patients with similar traumatic injuries to return to a normal life,” said Dr. Higgins, Chief of Curtis National Hand Center.

When a miter saw accident left a contractor’s hand thumbless, surgeons at Curtis National Hand Center made him a new one.

Samuel Dillsworth arrived at MedStar Union Memorial by medivac in November with an injury known as a complete thumb avulsion amputation, in which the thumb was pulled entirely off the hand at its base – where the hand meets the wrist.

Toes serve as a nearly perfect replacements for amputated fingers since they are similar in almost every way having bone, tendon, joints, nerves, arteries and veins. In the most severe injuries, the big toe can be used to replace a thumb because of its greater potential to match the appearance of a thumb with plastic surgery. By harvesting only the smallest portion of the toe needed to reconstruct the thumb, patients do not experience difficulty with balance or walking. 

“My hands are my life,” said Mr. Dillsworth, a custom fabrication contractor. “I build cabinets from scratch and I love what I do. I need to use both my hands.”

Mr. Dillsworth’s injury presented a particular challenge: he lost the entire thumb and a long length of the bones that support the thumb base.  The destruction caused by the accident would normally have made his case impossible to reconstruct, even with use of his toe.

“Because of the patient’s substantial metacarpal loss, we felt a [big] toe transfer reconstruction would result in the new thumb being too short for adequate function. We had to create a novel procedure to give him the ability to use his hand again,” said Dr. Katz. “We planned a procedure involving adding length to the toe transfer by using a bone segment taken from the lower end of the femur, along with the small vessels on the medial surface of the bone.”

To make sure the toe and knee bones survived after transfer to the hand, Dr. Higgins and Dr. Katz together performed two simultaneous complicated microvascular surgeries.  They harvested the tissue from both sites, (the foot and knee), each carefully removed with their attached small blood vessels that would enable them to live in their new locations. Removing those structures with their vessels is known as a flap.  The surgeons affixed the toe flap to the femur bone flap. They restored blood supply to the parts by sewing the millimeter wide blood vessels under a microscope, using sutures thinner than human hair.  Combining these two flaps together, the surgeons were able to create, de novo, a full length thumb.

“I haven’t smiled so much in a long time,” Mr. Dillsworth said. “When they pulled the bandages off my hand I was afraid it would look freaky because my thumb was my toe, but it looks great. The next day I was actually moving my thumb.”

“Mr. Dillsworth can expect to use his hand in the same way he did prior to the accident,” said Dr. Higgins. “Toe-to-hand transfer surgery is the state-of-the-art reconstruction for the loss of multiple fingers or the thumb. Perfecting this technique is so gratifying because it enables us to give patients back their ability to grasp. No single operation of the hand vaults a patient’s function so dramatically.”

About Curtis National Hand Center
Since 1975, people all over the world have placed their hands in ours – Curtis National Hand Center. From repairing traumatic injuries to treating repetitive motion injuries, arthritic conditions and congenital differences, our goal is to restore the patient's use of the hand, wrist, arm, elbow and shoulder to the greatest degree possible. Our long history of experience, outstanding medical staff, and state-of-the-art facilities combine to create a treatment center that is the first choice in caring for the hand or arm, no matter how common or complex.

Today, Curtis National Hand Center is recognized as the largest, most experienced hand center in the nation. In fact, the hand center was designated by Congress as the National Center for the Treatment of the Hand and Upper Extremity. Call 877-UMH-HAND for a physician referral.

About MedStar Health
At MedStar Health, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. Our 30,000 associates and 4,700 affiliated physicians are committed to living this promise through our core SPIRIT values—Service, Patient first, Integrity, Respect, Innovation, and Teamwork—across our more than 300 locations including 10 hospitals, ambulatory, and urgent care centers. As the medical education and clinical partner of Georgetown University, MedStar Health is training future physician leaders to care for the whole person and is advancing care through the MedStar Health Research Institute. From our telemedicine and urgent care services to the region’s largest home health agency, we’re committed to providing high-quality health care that’s also easy and convenient for our patients. At MedStar Health—It’s how we treat people.

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