He’s All Thumbs--and Happy to Toe the Line

The instant after the accident, Gilbert Lucero didn’t know how badly he was hurt. But then he looked at his dad, brothers, son and nephews and saw their faces drop.

His right thumb and left index finger were missing; his left thumb was dangling by a nerve.

“To be perfectly honest,” he says now, “I just started running around like a chicken.”

Four months later, he has a right thumb again--doctors took his big toe and attached it to his hand, an operation that never had been done at that hospital. And Lucero can speak easily about that moment of horror.

It happened in October, during an elk hunt near Tres Piedras in northern New Mexico. Lucero was reloading his old-fashioned, muzzleloader rifle when it went off.

Lucero, 34, calmed himself and then took charge. He sent his father and his 5-year-old son into a tent, told other relatives to tourniquet his arms and headed for help.

By the time he was loaded into a truck, Lucero’s sense of humor had kicked in. “I was checking every camp to see if they had bagged my elk,” he said.

At the closest hospital, 90 minutes away in Taos, doctors gave Lucero a shot of morphine and had him airlifted to University Hospital in Albuquerque, where doctors saved his left thumb. His other wounds were temporarily stitched up.

A few weeks later, still in great pain, Lucero was sent to C. Luis Cuadro, a plastic and reconstructive surgeon.

“Let’s wait for this wound to heal, and then we’ll work on getting you a new thumb,” Cuadro told him.

Lucero listened intently to his options: He could have the web of his hand sliced deeper to create a small thumb stump, an idea which he said “grossed me out.”

Or he could have a sausage of fat taken from his waist and formed into an unmoving thumb, but then “I’d always be hitchhiking.”

The final option, which he eventually chose, was to remove the big toe from his right foot and fashion a thumb out of it--or a “thoe” as Cuadro called it.

“I figured I’d rather limp and be able to play catch with my kid and button my own pants and work,” Lucero said. “But I’m not even going to limp.”

Before the surgery, Cuadro warned Lucero there was a 10% chance it wouldn’t work, and then he’d be out a toe and a thumb.

“It’s a risk, because the toe has to be completely detached from the foot, then the small arteries have to be reconnected in the hand, and if the small arteries clog off then he would lose the toe,” Cuadro said.

The eight-hour surgery at Presbyterian Hospital in Albuquerque was grueling for both patient and doctor.

Cuadro spent the first two hours preparing the hand. He cut open the scar, scraped out excess bones and nerves, and prepared the artery and veins to receive the right toe.

Then he moved to the other end of Lucero’s body to take off the toe, cutting until it was dangling by one artery and vein. Cuadro snipped off the final threads and immediately dunked the toe in ice to protect the tissues.

“Then I held my breath and hoped that it lived,” he said.

For the next three hours, he pinned, wired and sewed the toe onto Lucero’s hand.

When Lucero awoke, the first thing Cuadro did was have him wiggle his new digit. “That made me happy right then and there,” Lucero said. “Real happy.”

Although the toe is gone, the ball of his toe remains with the skin smoothly wrapped around the end of Lucero’s foot.

And Lucero is proudly limping around in running shoes, repeating Cuadro’s story of a former patient who went on after a toe-to-thumb transplant to run a half-marathon.

Cuadro, who studied at Harvard Medical School, worked under transplant pioneer Dr. James May, chief of plastic and reconstructive surgery at Massachusetts General Hospital.

Lucero praises Cuadro’s work.

“He’s a damn good doctor. Man, just look what he did for me,” Lucero said, gazing proudly at his new appendage. “That’s my thumb. My big, fat thumb.”