Fall 2009

Toe to Hand

Transplant Restores Hand... and Self Confidence

Rocio Duran Poma is grateful to the doctors who have given her back the use of her hand.

On the morning of July 20, Rocio Duran Poma was wheeled into an AAMC operating room with nine fingers and 10 toes. More than 10 hours later, the young woman from Bolivia awoke to find her hands complete.

Ms. Duran Poma was the beneficiary of a toe-to-hand transfer for thumb reconstruction, a complex combination of orthopedic and microvascular surgery conducted by orthopedic surgeons Jeffrey Gelfand, M.D., and visiting orthopedic surgeon John A. McFadden, M.D., of the Medical University of South Carolina.

Ms. Duran Poma was injured while doing work on her mother’s house in La Paz, Bolivia, nearly two years ago. A boulder fell on her, injuring her ankle, clavicle and shoulder, and damaging her right hand to the point that the thumb had to be amputated. “The accident that took my thumb changed everything in my life,” said Ms. Duran Poma through a translator. “I was in school, and suddenly I couldn’t write. I was immediately self conscious, isolating myself from people and friends.”

By surgically attaching her right big toe to the position her thumb occupied on her right hand, Drs. Gelfand and McFadden began the process that will allow Ms. Duran Poma to once again regain nearly full function of her right hand.

“Without an opposable thumb, a patient loses all the unique functions of a human hand,” said Dr. Gelfand. “The loss of a thumb can devastate a person’s ability to grasp and manipulate objects. A toe-to-hand transfer can restore stability, strength and mobility to the human hand by recreating the opposable thumb.”

Ms. Duran Poma was brought from Bolivia to AAMC by the Helping Hands Foundation, a group of surgeons on the AAMC medical staff who perform reconstructive surgery on individuals who typically would not have treatment because of cost or lack of access.

According to Dr. Gelfand, she was an ideal surgical candidate for the procedure. Her amputation had left the muscles, arteries, and nerves that moved and provided sensation for the thumb intact—only the thumb was missing. Through microsurgery, surgeons transferred her toe to her hand and attached those viable structures of her hand to the nerves, tendons, bones, and blood vessels of her toe.

The surgery was the first of its kind at AAMC. She returned home in mid- August, where she undergoes rehabilitation and continues her recovery. She no longer wears a glove to hide her injury and enjoys restored confidence.

“I want to thank the doctors who repaired my hand, for giving my life back to me,” she said. “The nurses who cared for me after my operation were very kind, and I am grateful to return home to be with my family, friends, and return to my studies.”

– Justin Paquette

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