Sentara plastic surgeon used patient's toe to replace severed thumb

A steel beam smashed and severed a Hampton Roads construction worker’s left thumb. In an instant, a young man’s work life was in jeopardy. An attempt to re-attach the thumb was unsuccessful because of the physical damage. That’s when Sentara Plastic and Reconstructive Surgeon Manas Nigam, M.D. entered the conversation.

“We considered an extension device or a prosthetic,” Dr. Nigam said, “but that’s not the same as a natural finger.” The next step involved an unusual procedure to use one of the patient’s toes to replace the missing thumb.

“This surgery is not done regularly in the U.S.,” Dr. Nigam said. “It’s done more in Asian countries for cultural and cosmetic reasons.” Borrowing a toe that closely matches the lost thumb offers a more functional result than other options.

“You have sensation, full motion, and all the joints and tendons,” Dr. Nigam said. “It’s a natural result, you can say, and that’s what our patient decided to do.”

Dr. Nigam and a co-surgeon performed the nine-hour operation at Sentara Norfolk General Hospital, a regional Level I trauma and tertiary referral center with the capability to provide complex care. They surgically amputated the second toe on the patient’s right foot and used it to replace the left thumb. Now begins a long recovery and therapy.

“It takes a team,” Dr. Nigam added. “You need surgeons specialized in microsurgery to connect the tiny vessels, nerves and tendons. You need a specialized hand therapy program to help the patient regain normal function. We have that at Sentara Plastic Surgery Specialists, and the patient trusted us to repair his hand.”

The patient is choosing to remain anonymous, but he agreed to let Sentara tell the story of this unusual procedure. Two weeks after the surgery, Dr. Nigam and senior medical assistant Patricia Disney unwrapped and examined the hand and foot during an office visit and noted good progress. Disney gently washed the hand with antiseptic soap. The surgical site is still healing - but it’s working.

“He’s already able to touch all his fingers to his thumb and he has some flexion at the joint,” Dr. Nigam observed. Barely three weeks out, “He’s far enough along that we can start his therapy program.” 

Rachel Spencer is an occupational therapist with Sentara who specializes in hand therapy. She fashioned a plastic splint to protect the patient’s thumb, which he’ll need to remove every two hours for a series of gentle exercises to improve movement, control and sensation in the repaired thumb.

“You had surgery very soon after your injury, and that’s the best thing that could have happened,” Spencer told the patient through a Spanish interpreter. “Your brain still thinks your thumb is there,” she added. That sensation will help speed recovery while he sees Spencer for therapy two or three times per week.

“Our goal will be to have your thumb start acting normally,” she said. 

Dr. Nigam’s goal is a bit more expansive: “It’s always my goal to get people back to doing what they need to do and love to do.”