An eight-year-old born with a radial club hand, Lal Ding from Baltimore is now able to use his right hand, though slightly angled, is significantly functional and straighter after an operation. Doctors had successfully performed a complex microsurgery which involves taking a bone, joint and growth plate from his foot to make his hand move again.

“I have always been drawn to complex reconstructive cases,” said Dr Ryan Katz of the Curtis National Hand Center at MedStar Union Memorial Hospital.

“For me, it brings me satisfaction to see difficult problems solved. I love seeing patients who think there is no hope, or no alternative, be offered a potential solution to a complex problem.”

Surgery required two teams to manage boy’s hand and foot

The rare genetic condition had caused Lal to have a shortened forearm that curved towards his wrist at a 90-degree angle. He never had a thumb but just four fingers, with the index finger repositioned as his thumb in an earlier surgery.

Lal’s parents went to see Dr Katz in hopes that Lal’s hand could be straightened and allow him to continue to grow.

It was an innovative surgery requiring two teams – one at Lal’s foot led by Dr Katz and the other at his hand, led by Dr James Higgins. The brainchild of the pioneering procedure, Dr Simo Vilkki, had flown from Finland to Baltimore to consult during the surgery.

The procedure underwent four stages whereby the first two, mainly traditional, involved centralisation in which the hand was balanced on top of the wrist and then fixed in a straighter position. The third and last stage were more complex as it focused on the toe transfer and aimed at improving function, without hindering future growth.

The “foot” team preserved the blood supply and growth plates, as they removed Lal’s second toe and raised it to the arm to straighten the wrist. They then fused the bone to the forearm, creating a wrist joint for the wrist to function.

“You see the skin pinks up and it’s alive again. And it will be alive forever. And that’s what allows it to heal and that’s what allows it to grow,” he added.

“He can do anything he wants to do”

With a visibly functioning hand, Lal does physical therapy every week, learning how to use his wrist and fingers and hoping to improve dexterity. The focus is on the wrist extension and the mobility of his forearm where he is able to turn palm up and palm down.

Dr Katz noted that it is often a problem as children get older when they become aware that they are visibly different, and that becomes a physical focal point.

For Lal, he has no pain now and is able to walk without difficulty, according to the surgeon.

“I would love if his hand no longer draws unwanted attention and he can integrate well in class and society without unwanted stares,” Dr Katz said.

“I hope that with an improved hand posture and overall hand dexterity, he can do anything he wants to do.” MIMS

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