Groundbreaking surgeries performed on two young patients with hand deformities

Posted on 5 February 2019

With a pair of groundbreaking surgeries, Mediclinic Cape Town plastic surgeon Dr Mark van der Velde has helped two young patients with hand deformities.

Angelique, a four-year-old-girl from Cape Town, was born with bilateral symbrachydactyly. This often-inherited condition causes missing and shortened digits of various degrees, and in Angelique’s case, it left her with no left hand, and only a rudimentary thumb on her right.

Clayton, also from Cape Town, was left without fingers on either hand after his family home was destroyed in a fire. He was just under a year old at the time, and he spent two years in hospital. He is now 12.

Both children have been given a new lease on life by Mediclinic Cape Town plastic surgeon Dr Mark van der Velde, who is pioneering a groundbreaking microvascular foot-to-hand transfer technique. This is the first time the procedure has been performed on children in South Africa.

Dr Van Der Velde says he has been interested in surgical treatments for congenital hand deformities in children since he qualified as a surgeon. He has been working at a pro bono clinic at The Red Cross War Memorial Children’s Hospital once a week for 14 years. Both Angelique and Clayton came to his attention through that clinic.

At just six months old, Angelique underwent surgery to extend her the middle and ring fingers on her right hand. Then, just after she turned a year old, Dr Van Der Velde was able to lengthen her thumb with a third bone graft. Having reconstructed her thumb, doctors faced the challenge of her grasp. The improved fingers on her hand gave her the ability to grip objects with a fine pinch, but Dr Van Der Velde believed they could do better.

In September 2018, a team of specialists led by Dr Van Der Velde successfully performed rare microvascular foot-to-hand transfer surgery. “To improve and widen her grasp, we had to put something on the other side of her hand,” he says. We brought in a new little finger: tendons, nerves, and a moveable finger, which was a second toe.”

Clayton’s surgery followed a few months later, and involved building a whole new thumb. “Even with no other fingers, a thumb is very useful, as it can oppose and grip against what is left of the rest of his hand.” However, this surgery is not a simple as it sounds.

To begin, Dr Van Der Velde identifies structures in the toe that are similar to those found in the hand. “This means we’re not just looking to transplant the digit itself. We cut long, right up and into the foot. To be effective, we need to take everything – the blood supply, nerves and tendons – and transplant all of it into the hand.”

Dr Van Der Velde says that while the adult version of this procedure usually takes between 15 and 17 hours, Angelique’s surgery took a “relatively quick” 11 hours, and Clayton’s procedure lasted 9 hours and 30 minutes. “Cutting out the nerves and reattaching everything to ensure optimal blood supply is a delicate process that can’t really be rushed,” he says.

There is a lot of work to be done before the doctors begin to scrub in, too. “I spent four years researching how to do this surgery before we went ahead with Angelique’s operation,” he says. “I went to fellowships in Argentina and Australia. I spoke to the president of the Hand Society in the US. It just is incredibly rare, even overseas.” In the end, he lent most on the expertise of Professor Simon Kay, a plastic surgeon in the UK who performed the country’s first double hand transplant and is widely regarded as the pre-eminent expert in this field throughout the European region.

Angelique and Clayton are both showing positive signs. “Their new fingers are alive, so the blood supply is functioning well. And both children have some good movement already. They will most likely require some follow-up surgery to loosen the tendons,” he says. “That is a fairly standard part of this procedure, worldwide. So far, they are recovering very well.”

Dr Van Der Velde says he is actively looking for new patients who are in need, and has “three or four” cases lined up for 2019. He can be reached via his private practice at http://www.capetownplasticsurgery.co.za/contact-us/, or through The South African Red Cross Society at https://www.westerncape.gov.za/your_gov/149.