Ahmed and fibula

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                                          Ahmed and fibula

Ahmed was a young Iraqi teenager who was finishing school and preparing to go to college, but life had some other plans for him. His right knee started hurting and swelling.He tried to ignore it but could not do so as the symptoms persisted. he was taken to a local orthopedic surgeon who advised X ray . Results was ominous, and treatment advised was disaster; dis-articulation from hip. After recovering from the initial shock his family went around searching for the best possible way to save his limb.it was 2013 , Iraq was in the state of civil war ,health care resources were at an all time low. Advanced and specialized treatment was available overseas only. India,Turkey, Lebanon and Iran were popular destinations.

India benefited from a long period of peace and prosperity, this allowed people to get educated and the economy to grow . As population grew government was unable to invest in quality healthcare , so as a result private investment come to healthcare. This led to the building of some of the finest hospitals in the country. Arab countries have always been in some kind of turmoil, cheap and quality healthcare attracted them and they come in droves. They were lapped up Indian private hospitals. They pay in cash and bring in additional volume.
Ahmed came to India in 2015 January when he was given treatment plan of chemotherapy 4 cycles followed by surgery. First cycle of chemotherapy was given in India , other 3 cycles were received in Iraq. Surgery was planned six months after chemotherapy ,patient come back to Fortis Gurugram .He  was under follow up of Dr Hemant Sharma an orthopedic surgeon.
A surgical team consisting of surigical oncology team under Dr Vedant Kabra  for resection of tumor, Dr Hemant Sharma for orthopedic surgery and I was called for reconstruction. Plan was cabana technique , which is vascularized fibula covered irradiated tumor bone after excision of tumor.



In may 2015 one fine morning we started, patient was wheeled in and intubated . Surgical oncology team got busy excising tumor and I prepped other leg for harvesting fibula. Excision was uneventful ,tumor was debaulked and bone was sent for radiotherapy.  When tumor bone returned we got busy reconstructing limb. Fibula was harvested ,femoral medullary cavity was bored out , fibula was placed into it. Femur bone was split into two pieces vertically and window was created for vascular pedicle. Whole construct was plated by orthopedic team led Dr Hemant Sharma,, after that it was my job to connect vascular pedicle to femoral vessels. Whole reconstruction went off nicely, but due to improper tourniquet application patient developed tourniquet palsy. It snowballed into major controvery but Dr Hemant handled it nicely . 
Patient under went emergency fasciotomy and under went skin grafting on post op day 5 . Patient gradually recovered  and was discharged . After six months patient gradually recovered from tourniquet palsy. Gradually he's bone united and he returned to his life,
Microvascular surgery offers a good reconstructive tool to find solution to the problems which other wise are difficult to manage.



Dr Adhishwar Sharma
MBBS,MS General Surgery(PGIMER)
Mch Plastic Surgery 
8860650846, adhishwar7@gmail.com 






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