Toe-Hold On A New Life Rare Surgery Replaces Injured Thumb With Man’s Big Toe

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.”

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