Carpenter gets his career back after toe-to-thumb transplant

A carpenter who lost part of his hand in a work accident has had a second chance at his career after surgeons used one of his toes to create a new thumb.

Craftsman Marcin Michalec received a toe-to-thumb transplant, which is a rare procedure for adults and more often used in children born with missing fingers.

In the 9-hour long operation, surgeons at St Thomas’ Hospital removed the second toe of Marcin’s right foot and transplanted it to become a new thumb for his injured left hand. He is now gaining feeling and movement in his new digit and is aiming to get back to the job he loves this autumn.

Dad-of-two Marcin had been working using a table milling machine in his south London workshop in April 2023 when his hand slipped and the machine sawed off his thumb and index finger on his left hand.

Helped by his son Slawomir, who was working with him, Marcin managed to apply a tourniquet while he was taken to hospital. Doctors were unfortunately unable to reattach his fingers and thumb, and suggested he have a prosthesis. However, this would have ended Marcin’s carpentry career as he needs to be able to use his left hand to guide his tools.

Marcin, 46, who now lives near Leicester and has been a carpenter and joiner for 29 years, said:

“I was devastated. I thought my life was over and a nightmare would begin because I couldn’t imagine any other life. I love the carpentry profession.”

Since his accident over a year ago, Marcin has had two operations to reconstruct the tendons to the fingers in his hand, then a third to attach his toe. Within a week of his third surgery he was walking normally and he is currently undergoing therapy to build up the strength and dexterity of his left hand.

George Murphy, consultant plastic surgeon at Guy’s and St Thomas’, led the team which undertook the complex operation for Marcin.

Mr Murphy said: “Marcin told us that he really wanted to be able to use his left hand to work, which he felt wouldn’t have been possible if he had a prosthesis. It’s relatively unusual for adults to have a toe transplanted to their hand – this is the first such transplant which has taken place for an adult at St Thomas’ in recent decades, and there are only a few centres in the UK performing this surgery.

“I thought Marcin would be a good candidate for this rare surgery. I’m glad he is making an excellent recovery and we hope he can start working again soon.”

Marcin said: “Mr Murphy explained the risks of the transplant to me. I understood them, but to me it was the best option which would give me the chance to continue in the profession I love. I need to be able to feel the tools, and to guide my chisel with my left hand.

“I’m full of optimism for the future now. The doctors and nurses have been fantastic. I will definitely return to carpentry as soon as the doctor tells me I can. I can’t wait.”

The first toe-to-hand transplant for an adult in the UK took place at Queen Victoria Hospital in East Grinstead in 1968. Since then, these transplants are still rare in adults and usually involve a series of operations. The second toe, next to the big toe, is usually used as it has the blood vessels, tendons and tissue needed for a successful transplant.

Removal of this toe doesn’t affect a person’s balance or ability to walk and run. If successful, the transplanted toe can provide a degree of feeling and dexterity although it won’t get the full range of movement that a natural finger or thumb would have.