Health

Toe to thumb surgery heals beautifully

Thursday, April 30, 2009

A follow up on a story we first brought you a year ago. Garret Lafever lost his thumb in a woodworking accident. It was a devastating loss since the thumb is responsible for 40 percent of function of the hand. But a team of doctors at St. Mary's Hospital in San Francisco offered him an unusual solution -- transplant his big toe in its place -- and it worked.

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In a thumb wrestling match, you might expect Garrett Lafever to hold the advantage. His right thumb used to be his big toe.

"Most people say they wouldn't notice unless I showed them, or you know compared it to one thumb or other, and I don't mind it, I think it looks pretty natural," says Garrett.

In a six-hour surgery at Saint Mary's Pros Center, Dr. Charles Lee, director of microsurgery, and plastic surgeon Dr. Scott Hansen of UCSF, worked in tandem to remove Garret's toe and reattach it where his thumb once was. It was an intricate operation disconnecting then reattaching blood vessels, nerves tendons and bone.

An X-ray shows just how well Garrett's toe transplant has healed. The base of his thumb is where the toe begins. Doctors then put a pin in place to hold it all together and it looks like it has healed beautifully.

ABC7 first met Garret last year, less than two months after the surgery and his new thumb has come a long way since then. He can now easily sign his name and button his clothes, but the flexibility of the digit is still not quite what doctors think it could be.

"He wasn't able to bring his thumb all the way across the palm and he isn't able to get a full extension of the thumb," says Dr. Lee.

"I think he has a great functional result, it's not perfect, but with the next operation, to break up the scar tissue, I believe we can get it a lot better," says Dr. Hansen.

In fact, the vast majority of patients who have this kind of transplantation, go back for a second, simpler surgery to remove that scar tissue. Dr. Lee and Dr. Hansen performed the operation the week after ABC7 last spoke to them. But even before that, Garrett was already pleased with the results.

"This had definitely been a big step up compared to what I had and I think it's going to be functional for the rest of my life," says Garrett.

As for his foot, he says he doesn't even notice that his toe is missing.

"His second toe now has compensated and deviated toward that side and created a more symmetric foot," says Dr. Hansen.

"I can go on long hikes, I can play Frisbee, I can wear any type of shoe I want, I can play basketball," says Garrett.

Garrett's given up cabinet making since his accident. He's now studying to be an electronic technician. His fine motor skills are that good.

"Attitude, which you can't ever quantify in a patient, is something that goes a long way in someone's recovery and Garrett, obviously, has done remarkable," says Dr. Lee.

Part One: Man replaces severed thumb with toe

RELATED LINK: www.StMarysMedicalCenter.org

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