Archive for the ‘News Articles’ Category
Friday, December 15th, 1995
Rare Surgery Replaces Injured Thumb With Man’s Big Toe
December 15, 1995 – Spokesman-Review
A plastic surgeon took medical technology in Spokane a step forward when he replaced a man’s severed thumb with his big toe.
It took three doctors, eight hours, and a patient who finally stopped laughing long enough to agree to the unusual procedure.
When James Bennett left the operating room, his swollen big toe perched next to the fingers on his right hand.
“I thought it was funny, putting your toe up where your thumb should be,” said Bennett, a drill operator who still chuckles when he looks at his bandaged new thumb.
Bennett, 36, expects he’ll soon return to work, play baseball with his sons and bowl – all vague dreams after a drill ripped off his thumb in mid-November.
The Dec. 6 surgery was the first of its kind in Spokane, performed by a plastic surgeon who has built a career around microscopic hand surgery.
Before moving from San Francisco a year ago, Dr. Alfonso Oliva successfully transferred more than 20 big toes to patients’ hands.
There was the man who sliced his thumb with a table saw, the mechanic who dropped a transmission on his thumb, the cowboy whose thumb was ripped off by a rodeo lasso.
Almost always, patients regain nearly full use of their hands.
Their gait and balance are near-normal, too, says Oliva, if he can avoid removing the joint connecting the toe and foot.
Bennett, of Osburn, Idaho, was drilling for gold deposits in mountains near Fairbanks, Alaska, when his hand caught on a plunging drill rod.
“All I felt was a little bit of numbness,” said Bennett. “My thumb went down the hole.”
As a co-worker drove him to the hospital, he tried to imagine life without a thumb. His buddies arrived shortly afterward with a surprise: His thumb, scooped up from the bottom of the drill hole. A surgeon reattached it the same day, Nov. 17.
But while he was home in Idaho for Thanksgiving, Bennett’s thumb began turning hard and black.
Dr. Oliva took one look and knew Bennett would lose the thumb.
Bennett laughed his deep laugh when Oliva offered to transplant his toe. Then he agreed: “I can’t imagine learning to be left-handed.”
Last week, surgeons Robert Cooper and Henry Lin and two teams of nurses joined Oliva in the operating room at Deaconess Medical Center.
One team removed Bennett’s right toe, while another prepared his hand for the transplant. Oliva attached the toe bone to Bennett’s hand with two small screws.
Peering through microscopes, the doctors used needles and nylon string finer than strands of hair to stitch together nerves, tendons, arteries and veins.
“They had to put another tendon in my toe – my thumb. Whatever,” said Bennett, who can’t decide what to call the digit.
“It’s amazing,” said Oliva. “It actually goes from being white to pink once the blood goes in it.”
Bennett’s thumb still looks distinctly like a big toe. For a while, he probably won’t fit his thumb in a bowling ball when his friends gather at the neighborhood alley.
But within two years, his toe will shrink to nearly the size of his other thumb, says Oliva. That’s because it won’t carry the weight of his body anymore.
Brain signals that once went to his thumb will now go to his toe, making it more sensitive to touch than before, Oliva said.
“He’ll have very good function,” predicts Oliva. Bennett’s three months of thumb therapy will begin with moving the digit on his own.
Bennett envisions himself back in the bowling alley and pitching baseballs in the back yard by early summer.
His boys are still puzzled by their dad’s new thumb, Bennett said.
“My 4-year-old didn’t even want to see it. But my 7-year-old thinks it’s pretty neat.”
Tuesday, June 12th, 1990
Skin, hair torn off vineyard manager in freak agricultural machinery accident
June 12. 1990 – by Larry Maatz of The Examiner Staff – San Francisco Examiner
In an extraordinarily rare and delicate operation, the scalp of a 33-year-old woman has been surgically reattached after it was torn from her head in a freak agricultural accident. Doctors say the woman, now recovering at San Francisco’s Davies Medical Center, is expected to show little if any outward evidence of her ordeal.
The 14-hour operation, a complete scalp and forehead replantation, has been performed only six times before, say hospital officials. The patient, a Northern California vineyard manager, was not identified.
“It was close to the wire” said Dr. Alfonso Oliva, who headed the team of five surgeons at the operating table. “The scalp had been completely torn off, from the eyelids to the nape of the neck.
“But we were able start blood flowing through the scalp within 12 hours of the accident. That’s close, but close enough to be successful.”
The woman’s hair had caught in the rotor of a sprayer crankshaft during routine vineyard operations on the morning of June 4.
Co-workers preserved the scalp, and the woman was rushed by ambulance first to a local hospital, then to Davies Medical Center.
Using microsurgical techniques, Oliva and his team reattached two of the major arteries to the scalp, ensuring an adequate blood supply. Then, three veins in the exposed skull were rejoined using vein grafts from the woman’s feet.
All in all, Oliva said, eight blood vessels ranging in size from 0.5 to 1.5 millimeters in diameter, “as small as the width of lead in a mechanical pencil,” were reattached, sewn together under high-powered microscopes.
But despite the extent and gruesome severity of the injury, the woman will emerge with little or no evidence of the accident. By luck, Oliva said, the location of the separations will allow most of the scars to be covered by natural skin folds and hair.
“The actual suture line is just above the eyelids, right where you would cut for a routine eye lift,” Oliva said. “The scars at the nape of the neck and above the ears will be covered by her hair.”
That leaves only a small scar across the bridge of the nose and a scar across each temple, he said, all of which can be readily dealt with by cosmetic surgery.
“I saw photographs of her taken before the accident,” Oliva said. “She was an attractive woman then; she will be an attractive woman when it’s over.”
The woman’s spirits are good, he said.
To maintain circulation in the reattached and grafted blood vessels, the woman must rest in an upright position; she cannot recline her head even against pillows.
“Two days after the surgery.” Oliva said, “she was sitting there joking about sleeping in a ‘Buddha position.’ This woman is going to do just fine.”