East Timorese immigrant regains thumb function after pioneering toe-to-thumb transfer surgery in Queensland

When an East Timorese immigrant working in a Queensland factory lost her thumb in a conveyor belt incident, she was "very sad" and feared the worst.

But now, eight months later, her surgeon has given her hope.

Francisca Amaral, 40, moved to the Sunshine Coast more than 10 years ago to work for a produce factory. She supports her partner, two teenage sons, mother and siblings, who all remain in East Timor.

She said losing her left thumb at work in January was "very scary" because she was "all alone" without her family.

Plastic surgeon Chandan Jadhav initially used a flap of skin from Ms Amaral's forearm as a cover.

Then, on July 16 at the Sunshine Coast University Private Hospital, he performed the region's first toe-to-thumb transfer.

Dr Jadhav said it was important to take three to six months to "mentally prepare" the patient.

"It's devastating, it's life-changing," he said.

"There's so much loss, and there's so much psychological trauma."

The "complex" 12-hour procedure involved transferring the patient's second toe to reconstruct a functional thumb.

Ms Amaral said when she woke up, she was in a lot of pain but was "very happy".

"My doctor is very good … they said everything will be OK," she said.

"They give a lot of hope and support."

Dr Jadhav studied medicine in India and had performed the surgery there about 15 years ago.

For Ms Amaral's operation, his team used her "entire toe".

"We took the flexor and extensor tendons, arteries, veins, nerves, along with the bone," Dr Jadhav said.

"We stabilised it with plates and screws on her forearm, and then we connected the tendons of the foot to the tendon of the forearm."

The medical team then re-established Ms Amaral's circulation by connecting the arteries and the veins.

'There's a lot at stake'

Dr Jadhav said he opted to use the second toe because it resembled a thumb and most patients were still able to walk well without it.

But he also noted "a lot of things" could "go wrong".

The entire surgery was performed under an operating microscope with a magnification of 12.5 times.

"You're stitching the ends of the vessels, which is like connecting pipes to each other … these pipes are very, very fine … less than a millimetre thick," Dr Jadhav said.

"It's a very fine art of reconstruction by using microsurgical techniques to attach these blood vessels so that the blood flow is restored."

Going into this surgery, Dr Jadhav said he was very aware of the risks.

"If it doesn't work, then you're losing the person's toe as well," he said.

"There's a lot at stake and you've got to get things right."

Dr Jadhav said the first recorded successful toe-to-thumb transfer was in the 1980s, but the concept appeared in ancient literature from 600BC, which formed part of his studies.

Surgery gets the thumbs-up

He said Ms Amaral's procedure was an emotional moment for him and the patient post-surgery.

"It's very gratifying to see the tears of joy in the patient when she woke up," Dr Jadhav said.

"The very next day, she was able to wiggle that toe, which is now functioning like a thumb, and that gives you an immense sense of joy and satisfaction and gratifies us and defines what plastic surgeons can do and create."

Ms Amaral will continue weekly hand therapy for the next six to 12 months.

The plastic-surgery team expected at least 80 per cent of her normal thumb functioning to return.

Dr Jadhav added that the surgery would also bring back more than 50 per cent of the hand's function.

"The biggest evolution came when we could move our thumb at a different plane, almost perpendicular to the plane of the rest of the fingers," he said.

The surgeon said this "opposition" was what enabled humans to grip objects and develop precision skills.

He said without thumbs humans were "incapacitated".

"I feel happy because I can use my thumb," Ms Amaral said.