The Bone Thief (Body Farm 5)
Hand surgery, too, has undergone remarkable advances. Toe-to-thumb transplantation, briefly discussed as a way to restore function to Dr. Garcia’s right hand, is a well-established and highly successful way to replace a missing thumb, as Asheville, North Carolina, hand surgeon Bruce Minkin — a former student of Dr. Bill Bass — explained to us in detail over dinner and via many subsequent e-mails. After a teenage patient lost his thumb and two fingers to an explosion, Dr. Minkin grafted one of the boy’s toes onto his mangled hand, creating a thumb that looks and functions almost like the original.
Total hand transplantation is, for now, an inspiring but experimental and very rare procedure. Worldwide, only about forty hand transplants have ever been performed; in the United States, just half a dozen patients have received transplanted hands — and only one has received a bilateral (double) transplant. Those numbers will rise, and the procedure will become more common, if Dr. Linda Cendales has her way. Dr. Cendales — the inspiration for the Emory surgeon we call Dr. Alvarez — is the only surgeon in the United States who has been formally trained in both hand surgery and transplant surgery.
Dr. Cendales helped perform two of the earliest U.S. transplants, including the 1999 transplant that — after more than a decade — remains the world’s most enduringly successful hand transplant. Dr. Cendales is not just a gifted surgeon, she’s also a pioneering researcher. She completed two research fellowships at the National Institutes for Health, focusing on ways to keep patients’ immune systems from rejecting transplants. Now, through a joint appointment at Emory University School of Medicine and the Atlanta VA Medical Center, Dr. Cendales is building a visionary new hand-transplant program, one that combines surgical expertise with immunological research. During the research for this book, Dr. Cendales graciously invited Jon Jefferson into her operating room to observe hand surgery. Using a curved needle and strong sutures, she carefully stitched together a severed tendon in a man’s hand, and then — peering through a microscope to guide an even more delicate part of the procedure — she snipped and spliced the ends of a damaged nerve together again. After the repairs were done, but before the hand was stitched shut, she flexed and straightened the sleeping patient’s index finger repeatedly, nodding with satisfaction as the reattached tendon slid smoothly within the remarkable cable-and-pulley mechanism of the human hand.
As the first edition of this book goes to press, Dr. Cendales is evaluating transplant candidates — and preparing to test a powerful new antirejection drug that she hopes will revolutionize transplant medicine and bring hope and hands to more real-life patients like our fictional Eddie Garcia.