Hand surgeon, child and brand new thumb

A conversation with 6-year-old Patrick Kirby leaves no doubt about who his heroes are.

First and foremost is his father, who died when Patrick was just 3 years old.

Second in line is University of Michigan Health pediatric surgeon Kevin Chung, M.D., who the young boy said, "gave me a thumb and helped my hand get all better."

Today, he can do all the things other kids his age are doing - and more, including dribbling a basketball with both hands, a talent he's most proud of.

A congenital hand condition

Patrick was born with a congenital hand condition. His right thumb had no bone structure and his right wrist was bent inward.

These conditions are just a few of the many Chung sees as chief of Hand Surgery and director of the Comprehensive Hand Center at University of Michigan Health.

Patrick's mother, Jessica, says there was never a question about who could offer the right treatment and the best possible outcome.

"Our pediatrician recommended Dr. Chung at the University of Michigan Health because of his exceptional expertise." That was enough for the family to take the next step: a meeting with Chung.

"The family came to see me when Patrick was a baby," said Chung. "I made a commitment that I would be his surgeon when the time was right."

Expertise over convenience

Because he had no thumb, Patrick's ability to do many activities as a young child and beyond would be hampered, says Chung, noting that a functional thumb is essential in the development of fine motor skills. This reinforces the importance of the surgery being performed at a major academic hospital with specialists in pediatric hand conditions.

"The thing for parents to focus on when choosing a surgeon is experience," Chung said. "A surgeon needs to consider a child's growth and development - and how that will impact the future." For this, he has told parents: "You need expertise, not convenience. You have one chance for your child and choosing the right surgeon can ensure the best outcome.

"Patrick is a testament to all the kids I see in my practice," said Chung, noting his team's commitment to caring for children with hand differences. "This is a reflection of all the options we have to help children thrive."

Like many children with congenital hand conditions, surgery is typically recommended at an early age. Patrick had his first operation at age 1 to correct the bone in his wrist, recalls Jessica. The second surgery, at age 2, was to create a new thumb for the toddler.

"We created a thumb for Patrick by repositioning his right index finger to the thumb position," said Chung. "This was an intricate procedure that needed to be done with elegance and precision. It has to be performed by a surgeon who understands the anatomy and what is involved, including moving the index finger with all relevant structures - such as bone, joint, tendon, nerve, blood vessels and skin - to the new thumb position.

"Patrick is a perfect example of what a well-executed procedure can provide - a long-lasting reward that allows Patrick to engage in all activities like other children."

Ongoing progress

Enrolled in an early head start program, Patrick was able to return to school a month after his surgery. There, his teachers encouraged him to use his right hand.

"He was hesitant at first and guarded his hand, but slowly got back to using it," said Jessica, adding that he still favors his left hand for activities like eating and coloring.

Occupational and physical therapy have also been a big part of Patrick's progress, she says. "Up until COVID, he had been participating in therapy three times a week, working on putting his shoes and socks on and other things that kids his age can do." Now, his teachers have taken over the strengthening exercises to make sure he continues to progress. Jessica says she plans to do the same once school is out.

Going forward, Chung and his team will monitor Patrick's development and anticipate how things may change as he grows.

"We need to consider what will happen years from now."

The casual observer may not even notice that Patrick is missing the index finger that now serves as a thumb. Born right-handed, Patrick's left hand became his dominant hand, although he's doing more and more with his right hand now that he's getting older and stronger, says Jessica.

"Dr. Chung describes Patrick's right hand as his 'helping' hand," she said. "He puts things in a language that kids can understand."

He also gives parents confidence in his ability.

"Dr. Chung not only explained the entire process for both procedures, he also showed us," said Jessica. "His expertise and passion made us feel that he was the right doctor for Patrick."

She says her happy, rambunctious son's wrist is now straight.

"You'd never know there was an issue. The scariest part was the second surgery and moving the finger over to the thumb position so Patrick could do the 'pinch grasp'." Now, he's thriving.

Most recently, his hand has gotten strong enough to buckle his seat belt, says Jessica. "Small steps, but we're getting there."

And if there's any doubt, Patrick's response when asked how he's doing these days will quickly clear the air.

"Good! Good! Good!" is his excited answer.

And his thoughts about Dr. Chung? "He's my favorite."