Three-Armed Baby to Have One Arm Removed

June 5, 2006 — -- Doctors in Shanghai, China, plan to remove an unusually well-formed third arm from a 2-month-old boy on Tuesday, The Associated Press reported today.

Tests have determined that the arm growing closer to the baby's chest is less developed and should be removed, said Chen Bochang, head of the orthopedics department at Shanghai Children's Medical Centre.

The surgery should last a few hours. The biggest risk to the baby, known as Jie-jie, is damage to nerves and blood vessels in the shoulder, AP reported.

"The current medical photography is not able to tell us exactly which nerves go where and where different nerves intercross. Therefore we have to be very careful during the operation to decide which nerves go where," Bochang said. "What I am mostly concerned about is his left hand, which I know very little about up to now. Since the baby is too small to undergo very detailed tests for his hand, we have to wait and see in the future."

A Rare Case

Jie-jie's story has been an intriguing one to doctors who treat birth defects.

During his medical career, Larry Hollier, co-director of the cranial facial surgery program at Texas Children's Hospital in Houston, has seen only two babies born with three arms.

In both cases, there was no question about which arm had to be removed.

"The third arm was not as developed, so it was a fairly easy decision to amputate," Hollier said.

Although rare, doctors have reported children born with extra extremities, such as arms, legs, fingers, toes.

They usually determine which to remove depending on how well it works. Hollier said there were no reliable statistics to say how common extra limbs or extremities were, especially because malformed fetuses were often aborted either spontaneously or surgically and therefore were not reported accurately.

When deciding which extremity to keep, doctors must carefully analyze the anatomy and physiology through imagery like X-rays and MRIs, which show bone structure and blood flow, as well as electro-diagnostic studies, which monitor nerve impulses from the brain to the muscle, doctors said.

Children with multiple digits and even hands are more common, said Ann Van Heest, an upper-extremity surgeon at Gillete Children's Speciality Healthcare in Minnesota. She has never seen a case like the baby in China.

How It Happens

Van Heest estimated that one out of 200,000 babies were born with two thumbs on one hand and one out of 2 million had doubling at the wrist, resulting in two hands.

To decide which extremity to remove, doctors usually wait until the child is 6 to 12 months old to perform any surgery, as they want to observe which extremity the child favors and uses more, Van Heest said.

"For a 2-month-old, I am not sure one would be ready to make that final assessment," she said.

Most cases of multiple limbs result from conjoined twins forming in development. One child does not survive and becomes essentially absorbed into the other, said Russell Jennings at the Children's Hospital in Boston.

In those cases, the extra limb is not connected to the baby's brain and the decision to amputate is straightforward. The cause of Jie-jie's extra arm seems unclear.

According to the evidence so far, Steven Stylianos of Miami Children's Hospital said he suspected that the extra limb most likely came about in the conjoined twin process.

Whatever the explanation, Jorge Lazzareff said he had confidence in the Shanghai doctors' skills. In the last four years, he has traveled to China several times to perform surgery on orphans with birth defects.

"The baby is in good hands, in my experience. They are up to the task," said Lazzareff, director of pediatric neurosurgery at the University of California Los Angeles.

Hollier said that infants tended to adapt to these disabilities. Their minds are at the early stage, so they can adapt to changes in motor development.

"Basically a child never misses a beat," he said.