Toe-to-thumb transplant – a first for Spartanburg Medical Center
It almost looks like a thumb now. It definitely works like one.
On Feb. 10, a log splitter cut Glenn Allum's left thumb off.
On Feb. 14, plastic surgeon Manny Trujillo, MD, spent 12 hours removing Glenn's big toe and attaching it where the thumb had once been. It's a microsurgery that has never been performed at Spartanburg Medical Center.
And on May 14, three months after the accident, Glenn showed just how dexterous his new thumb had become.
Occupational therapist Michael Maeder pulled out a wooden block with nine pegs protruding from the top. Glenn grabbed one side with his right hand.
“On your mark. Get set. Go,” Maeder said as he started a timer on his smartphone.
Glenn pinches a wooden peg between his middle finger and his new thumb, his index finger offering support. He pulls the peg out and drops it to the left of the board.
He repeats the action eight more times … and then begins to put each peg back into the board.
When he's done, the clock stops.
“31.26,” Maeder said.
Then comes the large yellow pad, where he'll perform the same exercise … with a lot more pegs.
Glenn, a Blacksburg, S.C., native, worked with his brother splitting logs on Feb. 10. The hydraulic machine works quickly, and a moment's distraction was all it took for Glenn to lose his thumb.
“It didn't hurt,” Glenn said. “It didn't bleed that much.”
The Level I Trauma Center is one of only five in South Carolina, a designation Spartanburg Medical Center earned by complying with strict standards set by the American College of Surgeons and the state Department of Health and Environmental Control's Trauma Advisory Council.
That's where Dr. Trujillo, a hand expert, received the case.
The log splitter crushed the blood vessels in the thumb, which made it almost impossible to reattach, Dr. Trujillo said. Instead, he approached Glenn and his family with an idea – what if he removed the big toe from his left foot and attached it where the thumb had been?
While the family considered the option, Dr. Trujillo consulted with other Spartanburg Regional experts, including plastic surgeon Michael Orseck, MD, and Brian Thurston, MD, director of trauma services and trauma surgeon at Spartanburg Medical Center.
“I got institutional buy-in, which was important,” Dr. Trujillo said.
Most people take their thumbs for granted, but they are essential for everyday living. Scientifically speaking, humans have “opposable thumbs,” which means that the thumb can touch every other finger.
Everyday tasks like gripping items, picking up small objects, buttoning pants or holding tools are impossible without a thumb.
For Glenn and his family, the decision was simple.
“We said, ‘Whatever you got to do,'” Glenn said.
Attaching a limb, especially in this situation, isn't easy. It involves a technique called microsurgery, which uses precise instruments to connect blood vessels at the microscopic level.
Microsurgery was invented in 1921 by Swedish surgeon Carl-Olof Siggesson Nylén, who built the first surgical microscope.
The first second-toe-to-thumb transplant was performed in 1966; the first big-toe-to-thumb transplant was performed in 1968.
Performing the operation at Spartanburg Medical Center marked a major milestone for the hospital.
“It's the type of surgery that used to happen only at huge academic medical centers,” Dr. Trujillo said.
Glenn's surgery took 12 hours, and Dr. Orseck and medical residents assisted Dr. Trujillo.
This was not Glenn's first surgery. The 47-year-old suffered a cancerous brain tumor as a child, but survived. He lives independently, but has a close relationship with his father, Arthur Allum, who goes with Glenn to his medical appointments.
“I've seen miracles before,” Arthur said.
The father said he has complete confidence in Dr. Trujillo and the staff at Spartanburg Medical Center.
“He surrounds himself with great people,” Arthur said. “He is so caring.”
Glenn spent a week in the hospital after the surgery, and today he has almost complete maneuverability. His foot has also healed nicely, and Glenn has adapted to life without a big toe.
“I'd say he's pretty functional,” Maeder said. “He has been motivated, and motivated patients equal successful therapy, for sure.”
Now, Glenn and his father are getting ready for an adventure in Nicaragua … a mission trip to build houses and serve the less fortunate.
“You do what you can,” his father, Arthur said. “It could have been much worse, and it has been a real joy working with Dr. Trujillo and the nurses and staff, and Michael [the therapist].”