Plastic surgeon at St John's Hospital Dr Mahil Cherian explains that industrialisation and road accidents have rendered the loss of fingers common.

In the case of 18-year-old Jyoti, who lost the fingers of her right hand in a machine, the second toe of the right foot was used to replace the missing index finger. Dr Cherian says, ``If a person loses fingers of both his hands, preference is given to the right hand because the thumb and the index finger of the right hand contribute to as much as 60 per cent of the hand function.''

The procedure requires 15 to 20 hours of surgery, where a patient is anaesthetised. The second toe of either foot is isolated. ``Care is taken to avoid injury to the arteries, veins, nerves and tendons,'' he said.

After the toe isready for transfer, the toe is reconnected to the hand in place of the missing index finger, and the bone fixed. ``But the difficult part of the procedure is the restoration of blood circulation after the toe transplant because it needs reconnecting the arteries and veins, which are the size of a pencil lead,'' he said.

The procedure is known to be superior to prosthesis because the hand or fingers done up in prosthesis are incapable of independent movement or sensation, he said.

Blood circulation is restored using a high--powered microscope. The reconnection helps the transplanted toe regain sensation, which is important for hand function and patient rehabilitation. Skin from the groin is also used for further toe transfer in places where the skin is deficient.

St John's Hospital is one of the few centres in the country to perform such a surgery.

Can another individual, say a spouse or relative, donate the toe for transplant? ``A patient's own finger is preferred because of the match,'' says DrCherian. The entire procedure costs between Rs 20,000 and Rs 30,000.