Wednesday, April 8, 2015

Day 9: 5th Day of Surgeries in Can Tho

complete tibial agenesisThe biggest case of the day was also one of the biggest cases of the mission. The kids are always important because the earlier the medical team can treat their deformities, the more chances they have to be independent, go to school, and grow up with fewer physical challenges to face along the way.

This little girl had complete tibial agenesis, a major deformity of her right knee and ankle joints. She hopped everywhere instead of walking. She is bright, cheerful, and was hoping for a solution that would let her go to school. When she tried, the school sent her home because her deformity was considered a distraction to the other children and too much for the school to manage.

The word amputation is jarring, but this was the solution for this little girl. Dr. Nyska explained that this would bring her to normal. She had no tibia or patella, only a fibula, and her foot was essentially completely upside down from the ankle. Because of the missing bones, it wasn't possible to repair what was there. Instead, they needed to remove her lower leg to allow her to use a prosthesis.

It's not a decision made lightly. "It's emotionally difficult for us to take a leg from a child," he explained. "But it's best for her to have a normal life." The case was fascinating from a medical perspective, but preparing for it emotionally was challenging for everyone involved.

Technically speaking, the surgery would be quite simple, but the results would be life changing. "She won't need any more operations after this," he explained. "And with a prosthesis she can go to school, play with her friends -- whatever she wants to do from now on.

Many of the kids are scared, especially because the families aren't with the patients in the pre-surgery waiting areas. This little girl was ready. She was aware of what the procedure would be and was quite calm going into surgery. The surgery itself took 90 minutes and went well. She was sleepy when we first saw her in post-op recovery. The next day she was happily playing with paper cut-outs upstairs in the patient rooms. Her bright green cast seemed like the perfect color to match the energy of the little girl we met in our second day of screening.

With a prosthesis her deformity will be far less obvious to people she meets. She'll be able to meet them based on her personality, intelligence, and energy without being first evaluated on her physical appearance. I hope we see her on our next visit to Vietnam.

(Abstract of NIH article on tibial agenesis.)

More specific medical details:

Patient 1: 25-year-old man

  • Bilateral clubfoot
  • Procedure: Bilateral tendo-Achilles lengthening (TAL) with pantalar fusion

Patient 2: 5-year-old girl

  • Equinus, right
  • Procedure: Right gastroc release

Patient 3: 22-year-old woman

  • Post-polio with foot drop and equinus, right; polio at 2 months old
  • Procedure: Split tibialis anterior tendon transfer (STATT) and TAL, right

tibial agenesis
Patient 4: 5-year-old boy

  • Adhesion of flexor hallus longus (FHL) after previous surgery, left
  • Procedure: FHL release, left

Patient 5: 46-year-old female

  • Drop foot, right following fever at 4 years old
  • Procedure: Ankle fusion, right
Patient 6: 6-year-old girl

Patient 7: 75-year-old man

  • Motor vehicle accident at age 15, increasing difficulty walking over time
  • Procedure: Left triple with TAL
Patient 8: 53-year-old woman

  • Plantarflexed first ray, contracted plantar fascia, began after fever 12 years ago
  • Procedure: Dorsiflexion osetotomy of the first ray with plantar fascia release

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