An eight-year-old boy has been given back the use of his right hand after doctors used bones from his foot to fix it. Lal Ding, from Baltimore, Maryland, was born with 'radial club hand' - a rare, genetic condition where the radius (the inner bone that connects the elbow to the forearm) does not form properly. Lal had just a small remnant of the bone in his arm. It left him with no thumb and his hand bent inward at a 90 degree angle. Traditional surgery could have centralized his hand, but would also leave him with limited to no mobility, as well as impair growth. But thanks to the innovative surgery - the first of its kind performed in the US - doctors told Daily Mail Online that Lal is is picking up and grabbing things as fast as he can. Lal had already had a surgery to reposition his index finger to where his thumb should have been. But his parents wanted to know if there was anything that could be done to straighten the hand without impairing his development. So they went to MedStar Union Memorial Hospital where they met Dr Ryan Katz of the Curtis National Hand Center. Dr Katz and a team of doctors learned of an innovative procedure, created by a Finnish micro-surgeon, that would take a bone, a joint and a growth plate from Lal's foot to create a functioning hand and arm. 'I love complex cases, difficult surgical problems, this case had everything that I love about surgery,' Dr Katz told Daily Mail Online. The creator of the procedure, Dr Simo Vilkki, flew from Finland to Baltimore to consult during the unprecedented eight-hour procedure, which required one team for Lal's foot, led by Dr Katz, and one for his arm, led by Dr James Higgins. The first two steps of the surgery are what is traditional: centralization, where the hand is balanced on top of the wrist, and then fixed in a straighter position. But the third and most complex stage would improve function and not impair future growth: the toe transfer. Lal's second toe from his right foot, along with its blood supply, was removed and transferred to the arm to definitively straighten the wrist. The bone was then fused to the forearm to create a joint, allowing his wrist to be able to move. Dr Katz said: 'What we want to do is raise just the second toe, without injuring any of the other toes, while preserving its blood supply and preserving its growth plates. 'We use the second toe because it has a joint, it has extension, and it has growth plates, which provide motion, balance and growth. 'We take the entire bone, which goes all the way to the ankle, and we identify veins and arteries and keep them running with the toe. 'Once the toe is harvested, it gets transferred to the forearm and the bones are fused together.' Lal's arm has since gained almost two inches in length and his hand is significantly straighter than before. Dr Katz said Lal has no pain and is walking without difficulty. Currently, he goes to physical therapy every week, learning how to use his wrist and fingers and building dexterity. Specifically what is being focused on is wrist extension and the ability to turn his forearm palm up and palm down. 'It's often a problem as children get older, as they become aware of their difference, that it becomes a physical focal point,' Dr Katz said. 'That can sometimes affect growth and social development and I would love to see his hand not be an issue so he can integrate well in class and society without unwanted stares.' Source
