In Australia, worker loses thumb in factory accident; Plastic surgeon rebuilds it using her second toe after 12-hour operation

Eight months after losing her left thumb in a workplace accident, a 40-year-old East Timorese woman in Australia has regained hope of using her hand again after surgeons reconstructed the missing thumb using one of her toes. As per ABC news, Francisca Amaral, who has lived on Queensland’s Sunshine Coast for more than a decade, suffered the devastating injury in January when her hand became caught in a conveyor belt at the produce factory where she worked.

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Away from her family and living in Australia, Amaral said the accident was particularly frightening. Her partner, two teenage sons, mother and siblings remain in East Timor, leaving her to deal with the aftermath largely on her own.

A 12-hour operation to create a new thumb

Plastic surgeon Chandan Jadhav initially covered the injured area with tissue taken from Amaral’s forearm. The medical team then waited several months before attempting a much more complex reconstruction. On July 16, surgeons at Sunshine Coast University Private Hospital carried out what was described as the region’s first toe-to-thumb transfer. The operation lasted about 12 hours.

Doctors removed Amaral’s entire second toe and transplanted it to her hand, where it was shaped and connected to function as a thumb. The procedure involved transferring the toe’s bone, tendons, nerves, arteries and veins. The bone was secured with plates and screws, while the tendons from the foot were connected to those in the forearm. The surgeons then reconnected the tiny blood vessels to restore circulation to the transplanted tissue.

Why surgeons chose her second toe

The second toe was selected because its shape and size can make it a suitable replacement for a thumb. Losing it is also generally less disruptive to walking than losing the big toe. But the procedure carries significant risks.

The doctor told ABC that the blood vessels involved were less than a millimetre thick, meaning the surgical team had to work under a microscope at 12.5-times magnification.

The operation required microsurgical techniques to reconnect the vessels almost like joining two extremely fine pipes. If the transplant failed, Amaral could potentially have lost the toe as well as the original thumb.

Months of rehabilitation ahead

The operation is only the beginning of Amaral’s recovery. She is expected to undergo hand therapy every week for between six and 12 months as she learns to use the reconstructed thumb and regain strength and movement.

Doctors expect her to eventually recover at least 80 per cent of normal thumb function. The reconstruction is also expected to restore more than half of the overall function of the affected hand.

The thumb plays a crucial role in human movement because it can move across the palm and oppose the other fingers. That ability allows people to grip objects, perform precise movements and carry out many everyday tasks.

The procedure also reflects how far reconstructive microsurgery has developed. Toe-to-thumb transfers have been successfully performed for decades, while the basic concept of reconstructing missing body parts using tissue from elsewhere has much older roots.