Stony Brook amputates woman's toe to replace thumb

Shannon Elliott had to make a tough - and unusual - decision. Would she give up a big toe so that she could have a thumb?

On Nov. 1, Elliott, 25, of East Moriches, was walking down a street in Mastic when she was hit by a powerful M-80 firecracker thrown from a car. The firecracker exploded, and Elliott was rushed to Brookhaven Memorial Hospital Medical Center in East Patchogue, where the thumb and two forefingers on her left hand had to be amputated. No arrests have been made in the incident, according to a spokeswoman for the Suffolk County Police Department.

Elliott was referred to Dr. Jason Ganz, a plastic and hand surgeon at Stony Brook University Medical Center, for reconstructive surgery. Ganz recommended a rare and complicated surgery in which Elliott's left toe would be amputated to replace her thumb. If successful, that would give her almost full use of her hand.

But first, Elliott had to decide if she was willing to lose the toe. In the end, the mother of two said the decision wasn't that hard.

"With one toe I'm gaining a whole hand," she said. "There's no comparison."

On June 7, Ganz and a team of three other surgeons, two anesthesiologists, two nurses and a medical student successfully completed the 11-hour operation. Monday, Elliott is scheduled to go home, her new left thumb still bandaged and swollen but looking remarkably thumb-like.

That, Ganz said, is because "a hand is basically a foot turned at 90 degrees." The surgeon, who only a month ago reattached the hand of a worker when it was severed by a log-splitting machine, took five months to meticulously map out Elliott's operation. The procedure was a first both for Ganz and for the hospital, he said, adding that one or two such transplants are done in the United States each year.

Using the hospital's new high-resolution state-of-the-art CT scanner, Ganz was able to see with absolute clarity where all the arteries and veins were in the foot and hand so as to see which could be reattached to which. It turned out that the artery on top of the foot - used in 80 percent of such operations - wouldn't be able to provide the necessary blood flow, Ganz said, and the surgeon had to find another vessel, which made the operation trickier.

In the end, Ganz said, all of the planning paid off and the operation went off without a hitch. Ganz said that if Elliott's recovery continues as well as it has in the last two weeks, she should have 80 percent to 90 percent of function in her hand within six to nine months.

In many cases, the transplanted toe actually shrinks to the size of a thumb, Ganz said. And there are plans to attach prostheses to Elliott's missing fingers within the next two to three months.

Elliott faces nine months of therapy both for her hand and her foot. She said she is eager to resume her studies at Hunter College to become a certified medical assistant and eventually a registered nurse. But mostly she wants to be with her husband and two children, 5 and 2.

"I'd like to be able to be more normal," she said. "I'd like to cook and clean for my family."

As for the toe, she has hardly given it a thought.

Asked what she would miss most about not having it, Elliott had to think for a moment.

"I guess I'm going to miss flip-flops and open-toed shoes," she said.