Harry J. Buncke, M.D.
Working at first with monkeys in a makeshift operating theater in his garage, Harry J. Buncke learned to replace lost fingers with toes and helped spark a revolution in microsurgery.
When the San Francisco surgeon started his efforts in the late 1950s, the goal had eluded medicine for so long that few were even trying any more: to sew together the tiny nerves and blood vessels that keep tissue vital. The prize, Dr. Buncke knew, would be not just reattached fingers and ears but things yet unthought.
Today microsurgery is one of the fastest-growing surgical specialties, with applications including reconstructive breast surgery and "flaps"óchunks of flesh and bone transplanted to areas where tumors or injury have caused tissue loss. Face and limb transplants are technically feasible, limited only by the problem of rejection by the body's immune system.
Dr. Buncke died May 18 at age 85; he had been slowed in recent years by a subdural hematoma caused by a fall. "He made tissue transfer and transplant possible and even routine," says Robert Goldwyn, a a Bay Area 16-year-old who recovered well enough to become a courtroom defense lawyer. Such stories can be multiplied. Dr. Buncke used a couple of flaps from Indy car racer Rick Mears's shoulder to replace skin and muscle that had been sanded off his heels during a 1984 crash. Mr. Wears came back to win the 1988 Indianapolis 500.
During a 1985 earthquake in Mexico City, Francisco Bucio. a plastic surgery intern, lost four fingers on his operating hand when the hospital where he was working collapsed. Six months later, Dr. Buncke transplanted two of Dr. Bucio's toes to the hand, and six months after that Dr. Bucio was operating again, albeit using his uninjured hand to wield the scalpel. He later studied microsurgery at Dr. Buncke's unit at the Ralph K. Davies Medical Center, which is now part of the California Pacific Medical Center. Dr, Bucio today is the ambidextrous proprietor of a cosmetic surgery clinic in Tijuana. Dr. Buncke was "like a second father to me," he says. "I credit him with my career."
Born in Canada and raised in Maine, Dr, Buncke was the son of a papermill engineer. After World War II service in the Navy and medical studies in New York alongside his wife (later a dermatologist), he started training as a plastic surgeon. It was then that he got interested in the problem of reattaching severed limbs. "Here you'd have this part that looks perfect, chopped off with a saw," says his son, Gregg, also a surgeon. "There was nothing you could do for somebody who had lost their fingers."
A stint in a Glasgow, Scotland, burn unit in 1957 put him in contact with British researchers interested in microsurgery, and he continued his own investigations into the subject. He began designing his own surgical tools, including modified jeweler's instruments for forceps. After moving to San Mateo, Calif., in 1959, he drew on Silicon Valley know-how. From engineers, he learned to create metalized fibers of silk and nylon to craft surgical needles and sutures a fraction the width of a hair.
Denied grants, he built his own instruments and operated on animals in his garage in his spare time. His first success, the reimplantation of a rabbit ear in 1964, was reported in the British Journal of Plastic Surgery. The operation was significant because it involved the joining of veins under one millimeter in diameter. He did the first big toe-to-thumb transplant in a rhesus monkey in 1966. He liked to tell the story of smuggling the monkey into the hospital late at night for X-rays.
A British doctor who had studied microsurgery with Dr. Buncke performed the first human big-toe-to-thumb operation in 1968 on a cabinet maker who had an accident with a circular saw. But Dr. Buncke's first four attempts at repurposing toes as fingers ended in failure when the transferred digit died.
In 1972, Karl Tagler, a Redwood City, Calif., fireman, sliced off his thumb with an electric saw while building a house. After an operation to reattach the thumb failed, Dr. Buncke transplanted Mr, Tagler's big toe as a replacement. Contacted at his rural California home, Mr. Tagler says that 36 years later, "the thumb works beautifully," and is almost unnoticeable, although "people will notice I have a stronger grip than some people/' The fire department forced him to retire, but Mr. Tagler subsequently worked as a forest ranger and home builder, among other jobs.
Dr. Buncke continued to hone his techniques. He helped develop a two-surgeon microscope that is now standard equipment for microsurgery. Gregg Buncke followed his father into microsurgery and now leads the Buncke Clinic, which his father founded in 1970. Hundreds of surgeons have trained there.