After a diesel technician had his hand amputated following a workplace accident, a surgeon performed a starfish surgery to preserve the use of his nerves — allowing him to control the individual fingers on his new prosthetic.
Donahue Mackey was performing repairs on a standby generator in September of 2023 when his left hand got caught in the fan blades.
Mackey, who lives in the Bahamas and works as a diesel mechanic, quickly realized he had lost his fingers and asked his coworker to take him to the emergency room.
“We finally reached the hospital and we dashed inside, and everyone was in shock,” Mackey says. “When the doctor came, I cried out to him, ‘Please save my hand, I need it to take care of my family.’”
As the pain intensified, Mackey’s friends and family kept him calm until the orthopedic doctor arrived. But when the physician saw the severity of his injury, he said there was nothing he could do to save his hand, and that further amputation to the wrist may be required.
Mackey, whose livelihood depends on the use of his hands, wouldn’t accept this devastating response. He asked for a second opinion and to be airlifted to Miami.
“After the doctors told me there was nothing they could do, something deep down inside ofme told me not to accept this conclusion,” he says. “I was operating on faith.”
Mackey says his future, as well as his ability to work and provide for his family, was on the line, so he found it very difficult to accept ‘No’ as the final answer.
“In my experience as a field service technician, I have been placed in numerous situationswhere I had to find solutions and ways to satisfy my customers who do not like to hear ‘I don't know’ or ‘I can't fix it,’” he says. “They want results.”
A glimmer of hope at the University of Miami Health System
When Mackey arrived at Jackson Memorial Ryder Center emergency room in Miami, the doctors examined his injury and explained that because of the extent of the damages, the amount of debris, and the length of time that had passed, there was nothing they could do to restore his hand.
“That is when reality set in,” he says. “My life would never be the same.”
Although they wouldn’t be able to restore Mackey’s fingers, the doctors told Mackey they’d need to operate to clean up the wound. They also asked what he wanted to do with his severed fingers, a question that only deepened the depression he was feeling. He agreed to have his fingers cremated.
But his hope was soon restored. Mackey was lying alone in the Trauma Center when Natalia Fullerton, M.D., an orthopedist, came to visit him.
“She said that she was sorry about my accident and that they couldn't save my hand, but that she would give me the best care possible and also the best prosthetic,” Mackey says. “She referred to it as the Cadillac.”
Fullerton explained that they would perform a starfish surgery on him — a procedure that would allow him to manipulate each individual finger of a myoelectric prosthetic. These prostheses are powered by motors and batteries and can be controlled by electrical signals from an individual’s muscles. They are considered the closest thing to an anatomical limb.
“The biggest smile came on my face and I told her that she was my angel and that the Cadillac is my favorite car,” Mackey says. “She gave me great hope and a second chance.”
What is the starfish surgery?
The starfish surgery is for patients who’ve had or will have a partial hand amputation in which muscles located between the bones of the palm are moved — maintaining their nerve attachments — to a location on top of the bone and closer to the skin. This allows them to use the signal of those muscles to operate a myoelectric prosthesis, Fullerton tells Healthnews.
“Usually, it is very challenging, and sometimes not possible to move individual fingers in a myoelectric prosthetic,” Fullerton says. “This procedure allows the amputee to move the individual fingers in a manner that is easy and intuitive.”
Mackey, who had an amputation right through the palm but still had his deeper muscles between the bones, was the perfect candidate for it.
“I thought that if we could do the surgery, I could give him a much better outcome than a traditional amputation at that level,” Fullerton says.
Limb salvage is a growing field in plastics and orthopedic surgery because there is renewed and increased awareness of the impact of improving people's ability to ambulate and manipulate the world, Fullerton says.
As the understanding of the need to improve limb salvage outcomes has grown, so too have prosthetic technology and surgical procedures.
Some of these improvements include:
- A better understanding of the impact of nerve management during amputation
- New procedures to decrease phantom limb pain, including targeted muscle reinnervation
- New nerve procedures to improve prosthetic function by integrating the body’s nerve signals to move myoelectric prosthetics (like with the starfish surgery)
- New procedures and prosthetic technologies, such as osseointegration, for improved body awareness and mobility
- A renewed push for collaboration of surgeons, patient, and prosthetists for improved understanding of stump formation for optimal socket fit as well as prosthetic creation
How the starfish surgery helped Mackey
Mackey’s procedure went extremely well, Fullerton says, and they were able to move the muscles over the bones easily.
She says she felt confident that if the recovery period went well, Mackey would be left with a great result.
“Mr. Mackey was the best patient to have for this innovative procedure,” she says. “He followed all the instructions with confidence and a very positive attitude. I always think that in hand surgery, the surgery is one part, but a bigger part is the recovery team, including the therapists, prosthetics, PMR, psychologists, and the patient that really determines the outcome of the surgery.”
Just two weeks after receiving his prosthetic hand, Mackey was able to individually move the fingers of the myoelectric prosthetic. He was able to use his hand for daily tasks that require two hands, such as eating with a knife and getting dressed.
“The starfish surgery has given me the ability to be fitted with prosthetics that allowed
independent moment of limbs, allowing me to perform many tasks — simple tasks that I took for granted such as holding my son’s hand and playing with him, writing, using utensils or simply tying my shoelaces,” Mackey says.
He can also carry items as heavy as 40 lbs and use some of the necessary tools to perform work tasks.
“The starfish surgery has helped me to return to a level of normalcy as my new way of living evolves day by day,” Mackey says. “I lost my fingers, but I didn’t lose my life, and I thank God for giving me hope. I want to inspire others not to give up — there are doctors who can help them.”
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