A four-year-old girl named Anqelique is one of the country’s youngest patients to be the recipient of a successful microvascular foot-to-hand transfer.
This means that one of her toes is now a fully-functional finger. This unique surgery was recently performed at the renowned Red Cross War Memorial Children’s Hospital in Cape Town by a team of doctors headed by Dr Mark van der Velde.
Angelique was born with a condition called bilateral symbrachydactyly, which causes various degrees of missing and shortened digits. This typically occurs in one limb only, but Angelique was born without a hand on her left arm, as well as only a rudimentary thumb on her right hand.
This surgery was painstakingly planned and researched after Angelique’s parents, Dirk and Anna, approached Dr van der Velde for assistance. Her first surgery took place when she was just six months old, and this was to augment her right middle and ring fingers. Another surgery was performed when she was just over a year old, where she received a bone graft to lengthen her rudimentary thumb.
This surgery helped give her a very basic pincher grip.
“She needed a wider grasp, and, knowing that bone grafts don’t grow in proportion to the child, I sought the help of the world’s top pioneers of paediatric microvascular toe transfers who guided and encouraged me,” said Dr van der Velde.
Not too long ago, toe-to-hand transfers for congenital hand conditions were not though to hold much benefit for the patient.
“The difference between a bone graft and a whole toe transfer is that a graft is a single bone without a blood supply whereas a whole toe comes with a blood supply, nerves, tendons and nail and confers far more length than a graft,” the doctor explained.
Several toe transfers have taken place in South Africa over the past 15 years – but have largely been performed on adults who have lost digits in accidents. One case involved a toe-to-thumb transfer performed on a child burn victim and was performed 10 years ago, but there has never been a paediatric toe transfer performed on a child who was born without fingers.
“The Western Cape Health Department is extremely proud of the quality of work done by our highly trained team of clinicians. They continuously strive to provide outstanding tertiary care for all patients of the Western Cape and beyond. Our clinical team continues to soar, placing the Western Cape Department of Health on the global map by providing these life-changing surgeries,” said Western Cape MEC for Health, Nomafrench Mbombo.
During the 11 hour operation, the team of four doctors successfully built a finger for Angelique.
In the next few months she will work with occupational therapists and will be able to start moving the finger and grasping large objects between the new reconstruction and her bone-lengthened thumb.
“I am extremely grateful to the Red Cross Children’s Hospital team which comprised of nursing, anaesthetic, ICU, hand therapy staff and fellow plastic and orthopaedic surgeons; everybody gave of their best and their skill proved exemplary,” Dr van der Velde said.