Pediatric Microsurgery: Pinpoint Accuracy with Microscopic Anatomy Restores Normal Function

Lanie Liebovitz is a very vocal member of her rowing team, but she was almost speechless when she crushed her finger in March. Like she had done hundreds of times before, Lanie, a 14-year-old high school freshman at the time, was guiding a boat on the Chicago River when the wind suddenly gusted and slammed her finger between the boat and dock.

In the tense drive to Ann & Robert H. Lurie Children’s Hospital of Chicago, she sat uncharacteristically silent in pain and shock, telling her mom and dad, “Please do not talk.”

Her injury crushed her middle finger on her left hand—Lanie’s dominant hand— ripping off a large piece of skin and leaving a tendon exposed. But the extent of her injury and surgery to make her finger work again would be more than she and her family anticipated. But one thing was apparent: everyone involved had to work very fast to save that finger.

Speed: Essential

“We work quickly to assess and perform surgical interventions,” said Noopur Gangopadhyay, MD, Attending Physician in the Division of Plastic and Reconstructive Surgery, who performed surgery on Lanie’s finger. “The faster you can restore blood flow, the better outcome you will have with the function of the finger. Fingers should be revascularized and replanted within 24 hours maximum. In this case, our team restored blood flow in about eight hours from the time of the initial injury.” 

Dr. Gangopadhyay is among a new breed of plastic surgeons leading Lurie Children’s Reconstructive Microsurgery Program and worked to save Lanie’s finger. Microsurgery may be indicated when young patients need reconstruction of a part of the body, especially when small blood vessels and nerves are involved but are not discernable through normal vision. Microsurgeons reconstruct anatomy that is often less than 1 millimeter wide, using sutures narrower than a human hair, and use surgical microscopes that magnify 10-20 times larger than the unaided eye can see.

Microsurgeons who treat adults abound, but far fewer experts have the qualifications and experience to work with young patients. Lurie Children’s created its Reconstructive Microsurgery Program to bring appropriate expertise to youth and their families from surgeons who are adept with miniscule anatomy and know how to reconstruct tissues in children who are still growing.

Pediatric microsurgery may be necessary when “crush” injuries, such as Lanie’s, occur from trauma to different parts of the body. Microsurgeons also treat youth with congenital facial deformities such as congenital facial paralysis and craniofacial microsomia, rebuild tissues following tumor removal, and repair brachial plexus injuries where nerves that send signals from the spine to the shoulder, arm or hand are damaged, in addition to other abnormalities requiring nerve or vascular reconstruction.

Orthopaedic Component

Jill Larson, MD, Attending Physician in the Division of Orthopaedic Surgery, performed the first part of Lanie’s surgery by placing a pin in the finger to realign and stabilize the fractured bone.

To minimize further anesthesia time, Dr. Gangopadhyay helmed the second part of the reconstruction when microsurgery techniques were used. Both arteries in her middle finger along with one of the sensory nerves had been crushed, resulting in a gap between the ends of the vessels and nerves. A nerve graft, a vein graft from Lanie’s foot, and skin from her inner elbow were used to replace the tissues destroyed in the accident.

 

 

 

From two months after surgery (top) to now (bottom), Lanie’s finger continues to heal.  Following several months of post-operative hand therapy, and nerve and vessel re-growth, sensation has already started to return.

 

Following several months of post-operative hand therapy, nerve and vessel re-growth and follow-up care, partial sensation has returned to Lanie’s finger and more sensation is expected to return over time. She was able to participate in one of her favorite summer programs before her life at Lane Tech High School intensifies again: an annual sleep-away camp. “I know that I could have lost my finger and things could have been a lot different,” she says.