Surgeon Creates Colorful Cast Art at Shriners Children’s

Felicity Fishman, M.D. doesn’t just fix hand and finger differences in children, she also cares for their tiny hearts with customized cast art.

Young hand patients come to Shriners Children’s for a variety of orthopedic conditions including, syndactyly (or webbed fingers), the most common limb difference. Keaton’s mom noticed a difference in his tiny hands in the delivery room. “I noticed it right after he was born. The nurses hadn't even mentioned anything, but as soon as he was on my chest and I was inspecting him, I saw it on his fingers,” Lauren, his mom, said. Several of Keaton’s fingers were webbed together by skin.

The family came to Shriners Children’s for orthopedic care with pediatric hand surgeon Felicity Fishman, M.D., who recommended surgery. “Syndactyly may be treated with surgery to separate the webbed fingers to allow the child to have more typical finger growth and function in their hands,” Dr. Fishman said. As they discussed the surgical plan, the family also learned about Dr. Fishman’s special touch for patients. Each child and parents pick a custom design that Dr. Fishman hand draws on the cast applied after surgery.

You might say all surgeons are also artists. Their chosen canvas is bones, skin and muscles. Did you know that prior to picking up a scalpel, most surgeons mark the patient’s skin to guide the procedure ahead? “Pretty much every surgeon draws their proposed incision with a marker prior to actually incising (cutting) the skin,” Dr Fishman said. “Some surgeries require more complex drawings. Syndactyly uses a pattern of (skin) flaps to cover areas that are created with the separation of the digits. Other surgeries just require a straight line for the incision, but the placement is still crucial, which is why we draw it first.”

But in Dr. Fishman’s operating room, the case also ends with art. After the patient’s tiny fingers are separated, incisions closed, and a protective cast applied, in a few brief minutes as the cast sets, the surgical nurse has artist’s markers at the ready. Dr. Fishman, cellphone in hand, begins to draw. “The idea for the cast art always comes from the patient or parent. I ask the kids either in clinic or in preop what they would like drawn on their cast (or their parent if they are too young to communicate) so that it's personalized for them.” Dr. Fishman has created snowflakes for Frozen fans, dinosaurs, and even snowmen.

Keaton picked a T-Rex for the surgery on his left hand. He woke up with a bright green cast covered by the dinosaur. When it came time for round two on his other hand, he and his mom suggested a shark and one small fish. The decision was quickly made in the OR that the fish will be escaping the shark’s sharp teeth rather than ending up as shark food.

Glancing at her cellphone with a reference photo, Dr. Fishman creates custom art, often bringing in her orthopedic resident as co-artist. “I use the internet to look up an example of what the child has requested and that is why I am looking at my cellphone while drawing.” In a few short minutes the sterilized grey markers and some orange coloring, created the scene for Keaton on his watery blue cast.

Dr. Fishman says custom cast art is about much more than making the cast look fun. “Just like choosing a cast color, the personalized drawing helps to give the patient a bit more ‘control’ in a situation that is generally out of their control and can be scary/unpleasant.” It might even make wearing a cast ‘fun’ for some patients as they heal after surgery.

Six months later Keaton is done with his colorful casts and enjoying a busy 3-year-old life. “He has full function of his hands...nothing slows him down...no lingering pain or difficulty with his fingers at all,” Lauren said. “He is as wild and crazy as a 3-year-old boy should be, if not more!”