Sidra-HMC team performs world-first ortho-plastic oncology surgery

The young patient was referred to Sidra Medicine with a short history of hip pain. Initial x-rays prompted urgent CT and MRI scans at Sidra Medicine and a subsequent biopsy performed at HMC confirmed the diagnosis of Ewing’s Sarcoma of the left thigh bone, a rare type of cancer.Dr Ata Ur Rehman Maaz, senior attending physician at Sidra Medicine’s Paediatric Oncology Division said: “Ewing’s Sarcoma forms 2% of all childhood cancers and usually manifests between the ages of 10 and 20, so this child was particularly young for such a diagnosis. We immediately put her on a programme that included chemotherapy to stop the spread of the cancer.”The surgical approach was conceived by Dr Ahmed Mounir, senior consultant orthopaedic oncology surgeon at HMC and Dr Graeme Glass, senior attending plastic surgeon at Sidra Medicine. In a world first, they made a plan to exactly excise the part of the bone affected by the tumour and to reconstruct the excised bone by making an exact replica based on another bone taken from the patient and a custom cut bone graft. This construct was fitted together and a new blood supply was attached to the reconstructed bone under a microscope. Dr Glass, said: “Conceptually, this operation represents the next logical step in only a handful of cases described in the medical literature. The earliest similar cases used only the fibula, a non-weight bearing bone below the knee. Using this bone to reconstruct the hip and femur was less than ideal because the reconstruction was weak and late fractures occurred more often than not.”Dr Mounir, noted: “It was imperative that we successfully removed the tumour completely while keeping the head of the thigh bone and its growth plate with their blood supply intact. Many highly advanced techniques were used during surgery to achieve its main goal of excision of the tumour with microvascular preservation of the nutrient artery to the femoral head. This would help preserve the potential for the reconstructed limb to continue to grow and function normally. This is the first time in the world to have such procedure done successfully on such a young patient with bone tumour.”A team of over 10 surgeons, anaesthesiologists and nurses performed the surgery, which took over 20 hours. Dr Mounir was assisted by Sidra Medicine orthopaedic surgeons Dr Farhan Ali and Dr Talal Ibrahim who removed the tumour and then partnered with Dr Glass to dissect the nutrient artery to the femoral head and perform the microvascular reconstruction.Prof Ziyad M Hijazi, chief medical officer at Sidra Medicine said: “There has been no reported or recorded cases of such a reconstruction and this is the first case to be done in the world using a new ortho-plastic oncology technique. What Qatar is able to offer in the care and treatment of children with complex diseases can be rated as some of the best in the world and comparable to other world-leading children’s hospitals.”The patient is currently undergoing physiotherapy at Sidra Medicine, to ensure optimum function of her limb.