“This was an interesting case because it involves all of the super-specialized disciplines that fall within the purview of plastic surgery - bringing tiny nerves, arteries and veins together, fixing bones and repairing tendons. “It probably added four hours to the surgery,” Long says. Long says Ramey had an unusual arterial architecture in his foot that added significant complexity. Transplanting the second toe is technically more demanding - a fact that proved to be true in Ramey’s case. The tendons that supported the thumb are repaired and connected across the joints of its replacement to provide range of motion to the new appendage. Sensory nerves across the surfaces of the toe are connected to ensure sensation at the tip of the toe-thumb. Surgeons also must ensure adequate venous drainage, which means they must reconstruct veins and connect them to others. Additionally, the bone from the foot must be stabilized onto the recipient bone of the thumb. This is done using vessels that typically are only about two millimeters in diameter with sutures that are less than the width of a human hair. The mechanics of the transplant include joining the arteries at the original thumb position and at the donor site so that blood flow can be reestablished. X-rays of the foot and hand enabled Long to structure the bones at the time of the transplant. Long and his team used specialized angiograms of Ramey’s left hand and right foot to examine the blood vessels and map the toe-to-thumb transplant. “I was thinking more about functionality than what it would look like,” Ramey says. “He never would have been able to do them if his big toe had been used to replace his thumb.” “Cary’s goal was to return to the things he was doing before he got hurt,” Long says. He favored the transplant only if it could be done using his second toe. “However, when it’s feasible for us to achieve both goals, we always aim for that.”įor Ramey - a young man with an active lifestyle - removing his big toe was not an option. “I always emphasize to patients that function comes before appearance,” Long says. Though aesthetics play a role in the transplant decision, Long prefers that not be the primary reason for surgery. But the new thumb isn’t proportioned like a regular thumb, and the lack of a big toe can affect balance significantly, Long says. The majority of publicized toe-to-thumb transplants around the country involve the surgeon relocating the big toe to the hand.
Ramey is the second UAB patient to have the surgery in the past two years. Long says UAB is one of the few hospitals in the country - and the only one in Alabama - to perform toe-to-thumb transplants. Unless you sit there and look at my toes and count them, it’s hard to tell I even had one removed.” “I had no idea my foot was going to look that good,” Ramey says. He assumed there would be a gap between his big toe and the next instead, he saw four toes spaced equally. “I can’t believe how incredible everything looks. “It’s beyond what I imagined,” Ramey says. One week later, Long and resident Christi Blakkolb, M.D., unwrapped his left hand for the first time, giving him the first glimpse of his new appendage. 24 - two years and nine days after Ramey had lain in the wreckage of his Subaru Baja.Įven with his hand heavily wrapped, Ramey was moving his new thumb ever so slightly two days after surgery. Long, associate professor of plastic and reconstructive surgery, transplanted the second toe from Ramey’s right foot into the thumb position on his left hand in a 13-hour surgery Aug. After it happens, though, everything changes.”Īfter several consultations with Long and much deliberation, Ramey decided to have the rare surgery. “Most people don’t want a toe on their hand. “Before this happened, if someone had told me, ‘If you ever lose your thumb, we can use one of your toes to replace it,’ I probably would have said I’d never have that surgery,” Ramey says. But as time passed, he thought about an option UAB Surgeon James Long, M.D., had mentioned in the hospital - he could get a new thumb by transplanting one of his toes. In the days immediately following the accident, Ramey didn’t care that his thumb was missing he was alive. Ramey was rushed to UAB Hospital, but his thumb was not salvageable. He didn’t know his thumb was crushed and half his index finger was gone. His left hand was outside the vehicle, pinned under the roof. Ramey was left lying on his stomach on the roof inside his car.
The life of the energetic 24-year-old from Sneed almost ended two summers ago in an August car crash. He loves extreme sports, especially mountain biking and “rock climbing without the ropes.” Cary Ramey has the word Carpe tattooed on the underside of his right wrist and Diem tattooed on the left.