"I spent some time with the guardian and Jennifer explaining the options for creating a metacarpal hand. First she does have a thumb metatcarpal. There are two major components to creating some thumb function. The first is to create the web space. This is done by removing the index metacarpal, and occasionally the trapezium. The thumb metacarpal is held away from the hand by pins or external pins for about six weeks.

The second component is resurfacing and providing skin to the web space. Full thickness skin with subcutaneous tissue is best but none available at wrist level. That leaves a vascularized pedicle flap such as radial artery—advantages that can be done at the same time, but is slightly riskier for possibility of flap loss; also Jennifer may not have sufficient vessels. The other method is an attached pedicle flap. The initial attachment is done at time of web creation and the hand then stays attached to trunk for three to four weeks and then divided at second surgery. The latter is the most likely.

In order to make the decision , one test we need is an arteriogram to show us the blood vessels. If we do a flap, we often use two teams.

b>Nov. 10

From Carolyn

You readers are amazing. A while back I wrote a column asking for about $10,000-$12,000 to help pay for the cost of Jennifer's second round of facial reconstruction. The charitable fund at Fairfax Inova Hospital, which covered her first round, didn't have enough left in it for the second. Now it does. Readers sent in nearly $10,000 within six weeks. Jennifer's friends in Maryland also are raising some money. Thanks to all of you have helped Jennifer in so many ways.

Nov. 8

From Carolyn

Dr. Osterman examined Jennifer’s hand today and was pleased with its progress. Jennifer is no longer in pain and I have to say, just straightening out her wrist and hand really improves her whole arm’s appearance. My eyes aren’t drawn to her hand anymore. Abitimo and Jennifer have decided that instead of simply getting a prothetic (and maybe in place of it), Jennifer will undergo another surgery in which Osterman will create what’s known as a metacarpal hand by using at least one of the metacarpal bones to create a thumb. Jennifer will have some pincing action that way and should be able to do a much wider range of activities, including sewing.

Oct. 12

From Carolyn

Abitimo called me today. Jennifer is in a great deal of pain, more than from any of the facial reconstruction operations. That doesn’t surprise me considering everything that Dr. Osterman did. She was sleeping in her room at Abitimo’s house when I went to visit her. I didn’t realize she was sleeping on a box spring on the floor. It turned out that when her son Aaron and his wife Anna moved out, Anna took most of Jennifer’s bed. As soon as we could, Tim and I bought a simple metal bed frame and took an extra futon we had over for Jennifer. That won’t take away the pain, but she’ll at least be more comfortable.

Oct. 10

From Carolyn

The other part of Jennifer’s body that suffered serious burns wounds besides her face was her left hand. It looks burned and as if someone sliced part of it away, resulting in nothing beyond her metacarpals.

A specialist in Fairfax, Va. looked at Jennifer’s hand and then recommended a top hand surgeon in … Philadelphia! Dr. A. Lee Osterman works with the Philadelphia Hand Center and he is as terrific as the doc in Virginia said. Not only did he offer his talent pro bono, he got Jefferson Health System’s Methodist Hospital to provide all the other equipment and services pro bono. That makes Methodist and the Albert Einstein Healthcare Network, which is donating routine medical care for Jennifer, as the two local hospitals that stepped up to help Jennifer where others would not.

Today, Osterman straightened her bent wrist and hand. It took hours of surgery for him to move bones, muscles and everything else in her hand. I did not sit in on this procedure, so I don’t have any exact description. But I can only imagine how intricate this surgery must have been and how skilled Osterman must be. Jennifer is blessed to have two extraordinarily skilled surgeons - Dufresne and Osterman - helping her.

Sept. 28

From Carolyn

Today was Jennifer’s first surgery of the second round at Fairfax Inova Hospital in Fairfax, Va. This time, the plastic and reconstructive surgeon, Dr. Craig Dufresne, implanted two of the tissue expanders under her scalp. Last time, he put one there and one under her chest skin. That part of her body remains tender from the burns she suffered seven years ago. That, and her poor nutritional status when she first came to the United States, contributed to the surgical incision on her chest opening and the tissue expander coming out before Dufresne had injected as much saline solution as possible.