TRINIDAD AND TOBAGO: DAY THREE

Source: Blog Post

We’re still having fun here in Trinidad!  Today was a full OR slate with great cases.  The THP team and the local OR staff are continuing to work hard while having fun together.

Our lead-off case was Daniel, a two-year-old boy with a thumb-in-palm deformity associated with a hypoplastic thumb.

To address this we performed a first webspace Z-plasty, thumb MP chondrodesis, resection of an anomalous thumb abductor, and finally a transfer of the ring finger FDS to the thumb.  The result was another great looking thumb that will prove to be much more functional than it is currently.

Our next case was the beautiful twelve-year-old Roslyn.  She has bilateral syndromic camptodactyly that is causing a lot of dysfunction in her everyday life.

After FDS and volar PIP capsular releases, Z-plasties and PIP pinnings were performed, leaving her fingers looking much better than when we started.

After she recovers from this procedure she will need the same thing done for her dominant left hand – hopefully she’ll be ready to go for the next THP mission!

The final case of the day was the surgical highlight.  Rico is a 26-year-old male who was in an accident more than five years ago.

The accident left him with a dorsal hand degloving injury.  He was treated with a split-thickness skin graft, but he eventually developed MP extension contractures, a first webspace contracture, and generalized hand dysfunction.

We first saw Rico in the clinic yesterday and it was readily apparent that he was highly motivated to improve his hand function and willing to do whatever we recommended.  Our first thought was to excise the scar tissue and contracted skin and cover the defect with a radial forearm flap.  However, an Allen’s test quickly showed that he had an incompetent palmar arch, which was confirmed by ultrasound.

We then brainstormed to determine the best way to achieve soft-tissue coverage given the circumstances.  Ultimately, we decided to use our “Phone a Friend” lifeline and called Dr. Kevin Knox.

After this discussion, we decided to do a paraumbilical perforator (PUP) flap, which was a new procedure for some members of the team.  In the OR, the dorsal hand was debrided and the PUP flap was raised by staying in “the fizz” (one of Dr. Knox’s surgical pearls).

With the flap raised, the inset was easy with a perfect fit.

As great as the case went, I’m sure Rico will be more than ready to detach his hand from his abdomen here in three weeks!

We then took a quick break, dished out some hugs, and grabbed a drink before returning to the Centre for an evening of education.

A group of nearly 40 people, made up of orthopaedic surgeons, orthopaedic surgery residents, plastic surgeons, and occupational therapists from around the island arrived eager to learn from Drs. Weiland and Kozin.  Dr. Weiland led a discussion about distal radius fractures and the varied treatment options.

Following that great discussion, Dr. Kozin presented the background and team preparation for the first bilateral pediatric hand transplant.

The story of Zion Harvey is truly amazing and to hear the first-hand account by Dr. Kozin was moving – very few dry eyes were left in the crowd by the end.  If you haven’t done so already, check out Zion’s story here - it’s worth the time.  As Dr. Kozin said, he is “an old soul in a young body.”

Another great day has come to an end in Trinidad and we’re looking forward to what tomorrow has in store!