PUERTO BARRIOS, Guatemala –
The orange tiger toy danced and fell across the white sheets of the hospital bed, as two-year-old Thiago Palencia played while waiting impatiently for something to happen. He spent half an hour surrounded by the tan walls and dark red floor of the pre-operation waiting room. People continued to walk past him in their dark-blue scrubs and white lab coats. Some stopped to speak to him, but he just hugged the right corner of his bed in an attempt to avoid them. His mother, Ms. Palencia, smiled at him gently and tussled his hair in an attempt to calm him down. But Thiago whined in protest, moved his head away and continued to play with his toy. Why would his mother bring him from home, to a small boat, to a large boat, and to the hospital within? What was going on?
Since his birth in 2020, Thiago has lived with two conditions common in the Central American region but not typically seen together: syndactylism and polydactylism. In short, Thiago was born with six fingers and six toes, and his second and third fingers and toes were fused together. While his feet could function with these conditions, the fusion of his two fingers on both hands restricted his ability to use his hands properly.
During the hospital ship USNS Comfort’s (T-AH 20) mission stop to Guatemala in support of Continuing Promise 2022, Thiago was seen by the in-patient pediatric team at the medical site in Puerto Barrios, and Ms. Palencia expressed her desire to get her son’s hands fixed while he was still young. The surgical department agreed to admit him and perform the plastic surgery needed to remove Thiago’s extra fingers and separate the fused ones. On the morning of Oct. 29, Cmdr. Tamara Kemp, a plastic surgeon assigned to Comfort, planned to do exactly that.
“Conditions aside, Thiago is a completely normal, healthy little boy, who actually does quite well on his own,” said Kemp. “He loves to run around and play, and he uses his hands as best as he can.”
The first time Kemp saw Thiago was in the pediatric ward. He was running around and playing with his toys without straying too far from his mother. Even as the toys continuously dropped from his hands, Thiago didn’t miss a beat. He would pick them up and start running around again. During this time, with the help of Gloria, a Guatemalan translator, Kemp was able to talk with Ms. Palencia.
“She had been told previously that it would be recommended to have the fingers separated at a minimum and that the extra digits could be removed,” said Kemp. “But they did not have access to that kind of care. I’ve run into that with a lot of my patients here. They don’t have a plastic surgeon in the country, except for in the capital city. But that is a difficult trek for most people.”
Kemp’s surgical team, which consisted of three surgeons, a registered nurse, an anesthesiologist and two surgical technicians, all gathered in the operating room. Each surgeon surrounded Thiago, who rested peacefully on the operating table after being given anesthesia, and took turns evaluating his right hand. Under the bright white lights of the room, they could see the details of tiny hands, which were no bigger than a tennis ball. The fused middle and ring fingers and their under-developed fingernails curled slightly upward, and the small extra finger, which was the length and width of three grains of rice, stuck out prominently to the left of the pinky. After cleaning Thiago’s hands and sterilizing themselves, the team prepared to start the surgery.
Kemp and the registered nurse, Lt. Cmdr. Mark Soriano, gathered the team to brief them on Thiago’s case.
“The syndactyly will release the fused fingers and remove the extra digit,” said Kemp. “Then, we’ll reconstruct the area in between the two fingers using skin grafts, so he’ll be able to use all of his fingers individually.”
“Although we’re used to conducting or assisting with surgeries like this, let’s remember how important this is for this little boy,” said Soriano. “This will impact his life long after we’ve left Guatemala. This will change his life for the better. This is exactly why we’re here and why we do what we do, so let’s get to work.”
On that encouraging note, just before 9 a.m., Kemp made her first incision, and the surgery began. Over the course of five and a half hours, Kemp executed each cut and mark with the utmost precision, successfully splitting Thiago’s fused fingers, removing the extra digit and using the skin from the extra finger to perform skin grafts to fill in open areas between the middle and ring fingers.
“The surgery went fantastic, and he’s doing very well,” said Kemp. “He recovered in our children’s ward with his mother and went home the following morning. Both of his hands will be in casts for three weeks, and the casts allow the fingers to stay very straight and the incisions and skin grafts to heal. That is a lot to ask for a two-year-old, but they do adapt.”
On the morning of Oct. 30, with his arms resting on his mother’s shoulders and his toys stored safely in her bag, Thiago boarded the Comfort’s water shuttle and headed back to shore. In three weeks he will be able to pick up his tiger toy using five fingers for the first time in his life.
“Coming here and being able to provide a service that we know there’s no access to is very gratifying and a wonderful thing to be a part of,” Kemp concluded.
The Comfort may have disappeared from Thiago’s brown eyes, but the actions of Kemp’s surgical team, as well as the other medical staff on Comfort, will stick with him for the rest of his life.