Fingers from the Dead

Faced with a person who has lost a finger in an accident, most surgeons do little more than sew up the stump --though in some cases they may transplant one of the patient's own fingers, especially to replace a thumb. Russia's Dr. Viktor Kalnberz goes much further:

he sews on a finger taken from a cadaver. In this way, he says, he has restored a remarkable degree of utility to the damaged hands of five patients.

At Riga's Institute of Traumatology and Orthopedics, Kalnberz has collected a bank of dead men's fingers, trimmed the skin and soft tissues, refrigerated the remaining bone, ligaments, and ten dons at --70DEG C. To use one of those severed fingers, the inventive surgeon first pares a strip of skin loose from a patient's abdomen, leaving both ends of the strip still attached to provide a blood supply. The loose part of the strip is rolled around the cadaver bone and sutured in place. After almost a month in the hospital, the patient is sent home for about three months to see whether his system can adjust to the presence of the foreign tissue. He takes with him a metal clamp that he uses periodically to shut off the blood supply from one end of the finger roll. Once the implanted finger becomes adjusted to a one-way blood supply, the patient goes back to the hospital.

There, Dr. Kalnberz severs one end of the cadaver-finger roll, opens the stub from which the patient lost a finger, joins the implanted bone with a metal pin to whatever natural finger bone the patient has left. He also stitches ligaments and tendons together. The patient's bandaged hand is strapped to his belly, and stays in that position for five to six weeks. Only after that is the new finger cut loose from its remaining abdominal attachment. Two to four months later still, Dr. Kalnberz does whatever cosmetic remodeling is necessary on the transplanted finger.

Because finger nerves are too small for grafting, the transplanted digit has little or no sensation, and there is not much flexion at its joints. The new finger must be moved as a unit from the knuckle. This is no great drawback, particularly for thumb grafts, which have enabled patients to pick up and use tools, a pen, a spoon or a glass.

Though U.S. surgeons are skeptical and some scoff at the procedure, Dr. Kalnberz expects that more sensation will eventually develop in his patients' fingers. He even hopes to learn how to graft a fingernail in place.

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