Function and Freedom
Enhancing children’s abilities and independence through microsurgery
by DOUG WARD
Like so many children his age, three-year-old Bryn Whitehead delights in firing plastic balls out of air cannons, building towers out of wooden sticks and playing the giant piano at Science World. But there’s one attraction he’s never tried: the big, gerbil-like wheel designed to create energy has long been out of reach because the activity requires the use of two hands.
The feisty, red-headed Bryn was born with all five fingers on his left hand. His right hand, however, is his “little” hand, a descriptive that parents Adrienne Denham and Simon Whitehead, and Bryn himself, use to describe a thumb and four nubbins on that hand. He could wedge, balance, pry and steady, but his ability to pinch and grip was marginal. Creativity and problem-solving made up for any missing digits.
Last autumn brought with it huge change for Bryn, when his parents met with the team of pediatric plastic surgeons at BC Children’s Hospital, led by Dr. Cindy Verchere and Dr. Sean Bristol.
“We had always bristled at the notion of prosthetics, which seemed to them like a way to make Bryn appear more normal without adding any functionality,” recalls Adrienne. She and Simon were confident that Bryn would be fine without any surgical intervention, but they wanted to be sure they had explored the options, she says.
The plastic surgeons at BC Children’s Complex Upper Limb Clinic considered Bryn a suitable candidate for a toe-to-hand transplant – an increasingly common, intricate microsurgery. The risks of such a significant procedure weighed heavily on Bryn’s parents. Buoyed by support from family and friends, they decided to go ahead with the procedure, to give their son the opportunity to improve the functionality of his hand.
Plastic surgeons at BC Children’s Hospital treat everything from cleft lips and palates, craniofacial deformities, birth defects, birthmarks, to severe burns and scars.
“There really wasn’t anything we could do to make his hand look like an ordinary or a typical hand,” says Dr. Verchere. “But what we wanted to do was make sure that he is not missing out on functions we could provide him.”
Drs. Verchere and Bristol took the second toe of Bryn’s right foot and transplanted it on Bryn’s “little” hand, to give him the best grip possible. “We put it on the longest metacarpal bone, in a position where it would pinch against the thumb,” says Dr. Verchere.
The nine-hour operation involved four surgeons working in two teams: one that harvested the toe and another that prepared the hand. A toe-to-hand transplant has been compared previously by one American surgeon to “sewing together a chopped chive with a human hair.” Dr. Verchere says that comparison is accurate.
“We use a microscope to identify the structures. You need to find the blood vessels, arteries, one or two veins – and as many nerves as you can in the toe so you can hook them up to nerves in the hand,” Dr. Verchere says. “We put the cut end of one blood vessel against the cut end of another blood vessel. And we sew tiny sutures.”
Bryn was well-prepared for the procedure, and recovered quickly, says Adrienne.
“He awoke after nine hours of surgery, groggy and asking for popsicles. Thirty-six hours later he was eager to see his new finger and make it wiggle, and 48 hours later he was testing his lightly bandaged foot for stability. Seventy-two hours later he was playing competitive air hockey against a young boy recovering from heart surgery.”
One week later, he was back at daycare showing off his new foot and new finger to his buddies.
A month after the surgery, Dr. Verchere and the plastic surgery team removed the cast and gave the resilient Bryn his first test: he gingerly pinched a tiny sticker and held it in his “new” little hand.
Since Bryn’s movements were limited for the first few days after the cast was removed, Adrienne admits she had a few moments of doubt. But as Bryn became more comfortable testing what his new finger could accomplish, his hand grew stronger and her worries subsided.
“He has a claw-like grip and it’s very strong,” she says. “Thanks to the skilled team at BC Children’s Hospital, the gift of significantly improved functionality will serve him well for the rest of his life.”
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