Loyola Medicine Hand Surgeons Perform Toe-to-Thumb Transfer

MAYWOOD, IL – After Melo Hairapetian severed his left thumb while using a circular saw, Loyola Medicine hand surgeons Sonya Agnew, MD, and Sameer Puri, MD, replaced it with Mr. Hairapetian's big toe.

"I can't live without my thumb," said Mr. Hairapetian, 45, of Morris, Illinois. "I used to be a mechanic. I live by my hands."

In a lengthy surgery, Drs. Agnew and Puri removed the big toe from Mr. Hairapetian's left foot and attached it to his left hand. Using microsurgical techniques, they attached blood vessels, tendons, nerves, muscles and skin.

"Mr. Hairapetian's big toe is similar in size and bends the same way as a thumb, so this made it a great option," Dr. Agnew said.

The procedure, called a toe-to-thumb transfer, is one of the most challenging operations in the delicate field of hand surgery. It's performed only at centers such as Loyola that offer subspecialty, microsurgical expertise and a high level of post-operative care.

Dr. Puri, an orthopaedic surgeon, and Dr. Agnew, a plastic and reconstructive surgeon, both are fellowship trained in hand surgery. They collaborate often on complex cases. "Dr. Puri and I have overlapping skill sets," Dr. Agnew said. "We can do far more together as a team than we can accomplish as individual surgeons."

An opposable thumb is responsible for nearly half of a hand's function. Dr. Puri noted that, like a thumb, a big toe has tendons that flex and extend and nerves that provide sensitivity to the tip.

When transferred to the hand, a toe does not look identical to a natural thumb or provide as much range of motion. But Mr. Hairapetian's transferred toe will enable him to perform the activities of daily living. "Ultimately he will have near normal function," Dr. Agnew said.

Mr. Hairapetian is learning how to do such tasks as tying his shoes, zipping his jacket and fishing. "I'm very grateful," he said.

In sacrificing a big toe, a patient can lose some stability while walking and there can be residual pain. "But only professional athletes would notice a big change," Dr. Agnew said.

Mr. Hairapetian said it was well worth the tradeoff. "My remaining toes do what my big toe did," he said.

Drs. Puri and Agnew said the success of Mr. Harapetian's toe-to-thumb transfer is due in significant part to the rehabilitation he is doing with Kim Esposito OTR/L, CHT, a Loyola Medicine certified hand occupational therapist.

"Mr. Hairapetian has an unbelievable combination of determination and grit," Dr. Agnew said. "He also has a wonderful support network. All of these things combined have allowed him to have the results he has had."

Ms. Esposito said Mr. Hairapetian also has a terrific attitude. "He has faced the problem with the glass full," she said.

Loyola board certified surgeons use state-of-the-art medical and surgical techniques to repair problems of the hand, wrist and forearm. They recommend surgery only if non-surgical techniques such as medications or exercises do not provide relief.