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UHealth/Jackson First in Florida to Offer Surgery That Can Restore Full Hand Function After Finger Amputations

Dr. Natalia Fullerton is among the few hand surgeons in the world to perform the Starfish procedure, which readies patients with amputated fingers for a prosthesis that restores more normal hand function and independence.

Dr. Natalia Fullerton with patient Donahue Mackey and Dr. Christopher Alessia in a clinic room
From left: Dr. Natalia Fullerton, patient Donahue Mackey and Dr. Christopher Alessia.

Natalia Fullerton, M.D., M.S., performed Florida’s first Starfish surgical procedure at Jackson Memorial Hospital earlier this year. Starfish is a novel procedure for patients who have lost some or all of their fingers to amputation.

The procedure allows patients to to individually and intuitively control finger movement through the activation of individual hand muscles that have been relocated to control a hand prosthetic.

“I have performed one of only seven of these procedures in the world and trained with the developers of the Starfish procedure, Drs. Glenn Gaston and Bryan J. Loeffler, at the OrthoCarolina Hand Center in Charlotte,” said Dr. Fullerton, an assistant professor in the Department of Orthaepedics at the University of Miami Miller School of Medicine. “Our first patient is already making amazing strides.”

While other surgeries and prostheses allow people to move their hands, the Starfish procedure can result in opening and closing fingers. That means patients may be able to once again eat with a fork and knife or operate machinery. 

The Starfish surgery moves muscles between the fingers closer to the skin’s surface while maintaining electrical signals from the nerve. That readies the patient for an advanced myoelectric prosthetic that uses electromyography signals generated by muscles to control movement. 

Prior to the Starfish procedure, non-myoelectric prosthetics or myoelectric prosthetics that open and close a hand with certain finger configurations were the only options for patients who had lost entire fingers. Starfish developers collaborated with the Hanger Clinic in Charlotte to create the first prosthetic hand compatible with the surgery. 

“Our patient, Donahue Mackey, just received his,” Dr. Fullerton said.

Last year Mackey, a certified diesel technician, was doing a routine repair when his left hand was caught in the radiator fan while working as a repair technician at a Caterpillar dealer in The Bahamas.

He was 44 years old. Only a remnant of his thumb remained on his hand. 

“After my accident and coming to the realization that my hand could not be saved, I went into depression and lost hope for the future,” he said. “The fact that I couldn’t take care of my family and being able to care of my son was my greatest concern.” 

People like Donahue come to us full of fear and despair. Our goal is to help them achieve bright, productive futures and to make them feel whole again.
—Dr. Natalia Fullerton

Mackey was airlifted to Jackson Memorial Hospital, a tertiary care center, where he saw Dr. Fullerton.

“She told me her plans, and it gave me hope that I could still have a productive life in spite of my accident,” Mackey said. 

Mackey said he couldn’t write, tie his shoelaces or button his shirt after the accident. His work suffered, as well. 

“At work, I no longer could perform my daily tasks in the field, resulting in me being transferred to the sales department,” he said. 

With his new prosthetic hand, he has regained much of his independence, including driving. 

“My handwriting with the prosthetic is surprisingly much better than it was before the accident,” he said. “At dinner, I don’t need assistance cutting my food. I can now properly hold a broom and sweep the floor and perform other household tasks. I can hold my son’s hand and play with him.”

The simple things he used to take for granted now give Mackey a once-unexpected joy.

“My new hand has given me hope and allows me to be an inspiration to others,” he said. “Even after my unfortunate accident, I can still live a ‘normal’ life. My story is also a testimony that miracles are still being performed and angels still exist in the form of doctors.”

Mackey added he is on his way to a full recovery.

Dr. Fullerton is now hoping to promote the Starfish procedure as an option for patients who have lost the distal phalanges—the smallest and shortest bones in the fingers—or just the fingers. 

Dr. Fullerton and patient 
 Donahue Mackey with health care providers in a clinic room.
Donahue Mackey (center, in red shirt) says his new hand “has given me hope and allows me to be an inspiration to others.”

“At UM we’re focused on being at the forefront of innovation in amputation care and giving patients the best possible outcome after this huge, life-changing thing they’re going through,” Dr. Fullerton said. “That includes holistic care beyond offering the most innovative approaches to surgery.”

Dr. Fullerton and the UHealth amputation team have launched a multidisciplinary amputation clinic to care for patients like Mackey throughout their journey.

“After amputation, people have chronic pain issues, phantom limb pain, neuromas,” she said. “They need to get their prostheses changed, psychological care and different types of therapy.” 

The UHealth multidisciplinary clinic offers specialized orthopedic and hand surgeons, physical medicine rehabilitation, occupational and physical therapy, and psychological support for the depression and anxiety that can stem from the trauma of losing a limb.

“People like Donahue come to us full of fear and despair,” Dr. Fullerton said. “Our goal is to help them achieve bright, productive futures and to make them feel whole again.”

Tags: Dr. Natalia Fullerton, hand surgery, Starfish procedure