Anna Barcelos

A new life

Giggling, Anna Barcelos is happy she can finally wear flip-flops. Previously the little girl’s big and second toes on her left foot were fused, making it impossible to wear the popular Y-strap shoe.

Dr. Peter Witt, medical director of pediatric plastic surgery at Children’s Hospital, improved this and other congenital deformities of Anna’s left hand and feet. “See!” says Anna as she proudly thrusts her arms straight out, wiggling her fingers and moving her feet. “I love Dr. Witt – he’s my BFF (best friend forever)!”

Anna was born with amniotic band syndrome (ABS), a rare condition caused by strands of the amniotic sac that entangle fingers, limbs or other parts of the fetus in the womb. ABS occurs about one in every 1,200 births and the cause is unknown.

The journey

“A journey of 1,000 miles must begin with a single step,” says the well-known Chinese proverb. Born in Central China in 2005, Anna was abandoned at a month old – on Christmas Day – in a small cardboard box outside an apartment building. Little did she know that the Barcelos family from Fresno had just decided to adopt a baby girl from her homeland. “We knew we wanted a girl from China with special needs,” says Kendra, adding that Anna fit in right away with their other four girls. “When we first met Anna, she was shy about her hands but she was obviously very bright.”

The Barcelos’s wanted to help Anna overcome her challenges. They knew of Dr. Witt’s reputation for being top in his field and his 20-year history of medical missionary trips to care for indigent children around the world. “He’s an amazing man and doctor,” says Kevin.

So work began. Anna’s left index and long fingers were fused, as were her ring and little fingers, her hand resembling a claw. Her fingers were short and she didn’t have any nails. Both of Anna’s feet had multiple constriction bands, and her left foot was missing its middle toe. Dr. Witt suggested a series of surgeries, spaced apart to reduce trauma. He completed one surgery in September 2008 and another two years later, surgically managing the constriction bands with excision and skin flaps, removing the nubbins, and using skin grafts from another part of Anna’s body to remove webbing between digits.

“Dr. Witt did a phenomenal job,” says Kevin. “The care was outstanding. He told us what to expect every step of the way and made sure we understood everything.”

“This is very delicate surgery – you need to know what to remove and what not to,” says Dr. Witt. The procedure also requires forethought about how it will affect the kids as they get older. “When a child’s left ring finger is involved, I’m especially conscious of how it will look – that’s their wedding ring finger,” says Dr. Witt.

A hopeful future

Right-handed, Anna uses her left hand more freely now. Just wearing gloves is significant, which wasn’t possible when four of her left hand fingers were fused.

Anna’s reconstructive surgery is complete but she may need further treatment later. About 15 percent of ABS patients require touch-up procedures as they grow and develop. While noticeably improved, Anna’s hands and feet remain a little different compared to others. Prior to surgery, Dr. Witt discussed with Kevin and Kendra challenges Anna may face, from reduced functionality to teasing from other children. In fact, much of what Dr. Witt and other physicians at Children’s Hospital do involves counseling the patient and their caregivers.

“The bottom line is that there are ways to improve the situation – there’s hope,” says Dr. Witt, noting that advances in medicine may provide patients like Anna greater treatment options in the future. “We provide materials to educate them. Kids are so resilient, they adapt well. Many do fantastic, live normal lives, even play pro ball.”

No longer concerned about hiding her hands and feet, Anna seems to be adjusting well, too, sitting in her chair, wiggling her feet, wearing her flip-flops.