A two-year-old boy who was born without thumbs is learning to use his hands for the first time after doctors surgically fashioned the digits from his index fingers.
Connor Woodle was born in Charlottesville in 2012 with a condition called thumb aplasia, which affects one in about 100,000 children.
Doctors said it was incredibly rare for a child to be born without thumbs but still have four normally-functioning fingers on each hand.
As he got older, Connor adjusted to not having thumbs and instead used his fingers like a crab claw to pick things up.
After an assessment at the University of Virginia Hand Center in the US, doctors decided to perform an operation called digit pollicisation.
The procedure involved removing Connor's index fingers, shortening them, and then attaching them to the place where his thumbs would have normally been.
Doctors knew the end result would still leave him only four fingers, but he would have a fully-functioning hand.
Connor went into hospital for the first operation when he was just one year old, involving surgeons reconnecting the vessels and nerves to create thumbs.
They wanted to ensure that the new thumbs would grow naturally with Connor, so that he wouldn't have tiny baby thumbs for the rest of his life.
He had two complex operation, seven months apart – and both were a success.
Dad Jason, from Charlottesville, described his emotions when he saw his son's first thumb.
He told Today.com: "I was in tears. It was a big, big thing for me to be able to see that.
"For him, too. For his first hand, when we took the cast off he held his hand up and he kind of stared at his hand."
Now two-and-a-half, Connor has quickly adjusted to his new hands and is capable of most things children the same age as him are. He can pick up tiny things, lift heavy objects, like a sippy cup filled with milk and use crayons.
Video: Watch how Connor got his thumbs