ANGELIQUE,

Team builds finger for girl in 11-hour operation at Red Cross Children’s Hospital

who was born without a left hand, and no fingers on her right hand, has undergone several surgeries, including the most recent one, in which her toe was attached to her hand and then augmented to create a finger. It is the first paediatric surgery of its kind in SA.

A 4-YEAR-OLD girl has become one of the youngest patients in South Africa to undergo a successful microvascular foot-to-hand transfer, where her toe is now a functioning digit on her hand.

This unique surgery was recently performed at the Red Cross War Memorial Children’s Hospital by a team headed by Dr Mark van der Velde, who painstakingly researched and planned the surgery to help Angelique gain mobility in her hand.

Angelique was born with bilateral symbrachydactyly, a congenital condition where there are various degrees of missing and shortened fingers.

Usually, symbrachydactyly occurs only in one limb, but in her case she was born without a hand on her left side and without fingers on her right hand – apart from a very rudimentary right thumb.

Angelique’s parents, Dirk and Anna, approached Dr Van der Velde for assistance, which saw Angelique undergo surgery at six months old to augment her right middle and ring fingers.

At just over 12 months, Van der Velde performed a third bone graft to lengthen Angelique’s thumb.

The small bone grafts helped to lengthen the little bit that she had and equipped her with a very basic fine pinch grasp.

“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.

“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,” said Van der Velde.

He said that, until fairly recently, toe-to-hand transfers for congenital hand conditions were thought to be contra-indicated, too technically demanding and unlikely to bring much benefit.

Over the past 15 years in South Africa, several toe transfers have been performed on adults who have lost fingers in accidents and a toe to thumb transfer in a child burn victim was completed 10 years ago, but there has never been a paediatric toe transfer for a child 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 Health MEC Nomafrench Mbombo.

During the 11-hour operation involving four surgeons, the team successfully built a finger for Angelique.

“I am extremely grateful to the Red Cross War Memorial Children’s Hospital team, which comprised nursing, anaesthetic, ICU, hand therapy staff and fellow plastic and orthopaedic surgeons. Everybody gave of their best and their skill proved exemplary,” said Van der Velde.

A graft is a single bone, but a whole toe comes with a blood supply, nerves, tendons and nail

MARK VAN DER VELDE Lead surgeon