Four-year-old Ajay from Haryana lost four fingers of his right hand in a freak accident after unknowingly putting his hand under a razor sharp cutter while his father was chopping hay. Now, almost three years later, Ajay uses his toes quite efficiently, to wield a cricket bat.
Amputated fingers are now being successfully transplanted with toes in India, thanks to a technique called microsurgical toe transfer. Two of Ajay's toes were transferred to form his thumb and middle finger. But lack of knowledge among patients has made the surgery highly uncommon.
According to plastic surgeon Dr Aditya Agarwal from Sir Gangaram Hospital, not more than 15 such surgeries may have taken place in Delhi. Surgeons say transfers provide functionally useful and cosmetically acceptable digits in children above two years and adults below 75 years.
Even though toe-to-hand surgery is one of the most technically demanding microsurgical operations, the success rate is greater than 95%. A toe transfer surgery lasts between 5-8 hours and the patient needs to stay in hospital for 7-10 days. While it takes two months for the hand to recover, sensation to the new fingers take anywhere between 6-9 months.
Dr Agarwal says, "Costing close to a lakh, the price of the surgery may have been a deterrent. But hospitals like Gangaram perform the surgery for free in patients who need it but can't afford it."
Experts say up to six toes, three from each foot, can be easily transferred. This ensures that the patients foot movement is not affected. Transferred toes are known to have equally good sensation like a finger and a wide range of movements. Using a microscope, doctors stretch tissue covering the nerve, called the epineurium, across the gap between hand and the toe. They attach the epineurium from the two main nerves in the base of the missing finger to the corresponding nerves in the replacement toe. They connect blood vessels and main tendons. Surgeons use manipulates to attach bones of the new finger to the bones in the hand. Difficult part of the procedure is the restoration of blood circulation after the toe transplant.