Microsurgery Changes Lives

By Lily Tung. Photography by Alain McLaughlin

Carlos Green performing parkour, also called freerunning.
It involves running, jumping, climbing, and vaulting through urban areas dense with obstacles.

Life Turns on a Dime
In March 2008, 13-year-old Carlos Green stood at a window in his Oakley home and lit an M-1000 firecracker. He pulled back his arm to throw it, looking forward to seeing it explode in the air. Instead, just moments later, he was being rushed to the hospital. Much of what happened right after the accident is a blur: Carlos’ father, Raul, rushing him to the ER; his mother, Irenis, racing to the hospital from work; a throng of siblings, relatives, and church friends arriving to lend support. But one indisputable fact remains clear: The firecracker exploded as it was leaving Carlos’ right hand, blowing away his thumb, his index finger, and half of his middle finger.


"It was a horrific sight to see," recalls Irenis. “He had such beautiful hands, and to see his hand destroyed that way…” The local hospital wanted Carlos to get the best treatment possible, so they transferred him to CPMC, part of the Sutter Health network, and home of some of the best microsurgeons in the country. “The thumb accounts for 50 percent of hand function,” says Carlos’ doctor, Darrell Brooks, M.D., staff surgeon in the Plastic Surgery Department. "Without it, you cannot grasp, so its loss is significant."

It Would Take a Miracle
“I didn’t think I was ever going to use my hand again,” remembers Carlos. After the accident, he couldn’t write, hold a cup, or use a fork and knife. “In fact, I couldn’t use my right hand to do anything,” he says.

His microsurgeons then proposed something that shocked him. They recommended taking one of his big toes and using it to reconstruct his thumb. The transplant, they said, would give Carlos the use, feel, and look of his hand back.

Microsurgery—surgery performed using a microscope—allows doctors to repair the tiny nerves and blood vessels that supply extremities and other small body parts. They can then perform tissue transplants to reattach limbs, digits, and even tongues.

Carlos was skeptical, at first. “I already lost my fingers, so I didn’t want to lose my toe, too.”

Second Chances
It’s now three years later, and Carlos is a 16-year-old junior at Freedom High School in Oakley. He’s missing a toe, but he has a right hand that, upon first glance, looks almost normal. He is a varsity golfer and an award-winning wrestler. He snowboards, does parkour, (which involves running, jumping and vaulting in urban areas) and runs long distances. He can squat 320 pounds and does countless repetitions of fingertip pushups—all while making the honor roll and taking three advanced placement (AP) classes.

And what about that missing toe? “Now I realize that losing my toe didn’t matter at all,” Carlos says.

Carlos recovered well from surgery. “Compared to adults, children rehab and adapt better,” Dr. Brooks explains. “If they lose a thumb and doctors transplant a toe, they can learn to use it normally. Other specialties, such as physical therapy, helped Carlos regain the use of his hand.

Carlos adapted so well that the surgery became a turning point in his life. Before his accident, the boy his mother describes as a couch potato wasn’t much interested in anything, least of all athletics. “But after his surgery, Carlos lost 50 pounds, started pushing his body to the limit, and didn’t put any restraints on himself,” Irenis says. “He was not just going to sit down and die. He was going to live.” He feels he got a second chance.

Changing Lives, One Child at a Time
Carlos is just one of many children who have gotten a second chance at CPMC, one of the few hospitals in California that specialize in pediatric microsurgery. Its
microsurgeons have repaired the limbs of children after serious accidents, helped babies who were born without fingers to pinch and grasp, and given kids with facial paralysis the chance to smile again.

These exceptional surgeries are not the only ingredient for successes like this. Pediatric microsurgery is part of a larger pediatric program at CPMC’s California Campus. Additional services—including the Pediatric ICU; hand and physical therapy specialties; pediatric anesthesiology, which keeps the smallest children pain-free; and Child Life Services, which help children cope with the stress of hospitalization—provide essential postoperative care and support for children and their families.

“The surgery absolutely made a difference in our lives,” Irenis says. “The microsurgeons at CPMC keep hope alive.”