A four-year-old toddler has undergone surgery to have a toe removed from her foot and transplanted to her hand, where it's meant to function as a finger.
Angelique is one of the youngest patients in South Africa to undergo successful microvascular foot-to-hand transfer.
She was born with a condition known as bilateral symbrachydactyly, where there are varying degrees of missing and/or shortened digits (fingers).
The toddler was born without a left hand and only a thumb, with limited use, on her right hand.
Not her first rodeo
Angelique's parents approached Dr Mark van der Velde for assistance, and at six months of age, she underwent surgery to build up her right middle and ring fingers.
At one year old, a third bone graft was done to the lengthen her thumb, and this helped to give her a very basic, fine-pinch grasp.
Finding the right people for the job
In a statement, van der Velde said that Angelique needed a wider grasp, and because bone grafts don't grow with the child, he needed help from some of the top paediatric microvascular toe transfer experts.
These experts guided and encouraged van der Velde as he took on the challenge to transfer Angelique's toe to her hand.
"The difference between a bone graft and a whole toe transfer is that a graft is a single bone without a blood supply, whereas a whole toe comes with a blood supply, nerves, tendons and nail and confers far more length than a graft," said van der Velde.
A long journey ahead
The procedure took 11 hours and involved four surgeons. The next few months will see Angelique working with occupational therapists to build up strength and mobility, where she should start moving her new finger, along with her bone-lengthened thumb, and grasping larger objects.
Over the past 15 years, South Africa has seen several toe transfers performed on adults who have lost fingers in various accidents, and a toe-to-thumb transfer in a child burn victim was done 10 years ago, but there hasn't yet been a paediatric toe transfer for a child born without fingers.
Stellar medical staff
Western Cape Minister of Health, Professor Nomafrench Mbombo, said, "The Western Cape Health Department is extremely proud of the quality of work done by our highly trained team of clinicians. They continuously strive to provide outstanding tertiary care for all patients of the Western Cape and beyond. Our clinical team continues to soar, placing the Western Cape Department of Health on the global map by providing these life-changing surgeries."
Van der Velde added that he is extremely grateful to the Red Cross War Memorial Children's Hospital staff. "The team consisted of nursing, anaesthetic, intensive care unit, hand therapy staff and fellow plastic and orthopaedic surgeons. Everybody gave their best and their skills proved exemplary," said van der Velde.