A 37-year-old KwaZulu-Natal man who had suffered a crush injury to his left lower leg, was discharged from hospital recently after having undergone a highly intricate, almost 10-hour, microsurgical free tissue transfer operation.
Mr Senzo Mbuyazi was delighted to be able to go home from Netcare Alberlito Hospital on the KwaZulu-Natal North Coast after spending close on a month in hospital. He had suffered the devastating crush injury in July, which had resulted in a compound fracture of his both his tibia and fibula bones.
“The surgical and medical teams are thrilled with the outcome of the procedure,” says Dr Trishan Pillay, a plastic and reconstructive surgeon who practises at the hospital. “Mr Mbuyazi’s exposed bone was completely covered by the transplanted tissue, and the nerves and tissue were integrating and healing well by the time he was discharged,” he adds.
“The new tissue will also enable the healing of the bone and we expect Mr Mbuyazi to have the full function of his leg restored within approximately five weeks.”
Dr Pillay says that, although the free tissue transfer procedure is not a new operation, it is highly complex requiring a multidisciplinary team that is trained in the technique. “It is the first time that the procedure has been completed at Netcare Alberlito Hospital and it undoubtedly assisted in saving the patient’s leg,” he adds.
Dr Pillay explains that the free tissue transfer operation involves transplanting living tissue from one region of the body to another and enables the reconstruction of complex injuries such as that experienced by Mr Mbuyazi.
He says that this type of surgery is extremely difficult owing to the complexity and intricacy of the blood and vascular, or circulatory, system. “It requires long hours in the operating room and a very steady hand as well as specialised microsurgical instrumentation and other equipment, including a high powered microscope, all of which we have at our disposal at the hospital.”
The KwaZulu-Natal man was first stabilised at Netcare The Bay Hospital, in Richard’s Bay, following his injury before being transferred to Netcare Alberlito Hospital for treatment.
“Initially the wound was still contaminated with some necrotic, or dead, tissue and debris. It therefore required a number of debridements, or procedures to remove this tissue, until the wound was healthy and ready to be closed,” observes Dr Pillay.
“The lower leg is a very difficult area to reconstruct owing to the limited tissue available that can be used to transfer to the wound. The international gold standard treatment option for this area is a free tissue transfer, so after careful consideration of all options, the team elected to go this route.”
The operation involved a multidisciplinary team that included Dr Sachin Baba, a resident orthopaedic surgeon at Netcare Alberlito Hospital, anaesthetist, Dr Leraj AK Lekha, and plastic and reconstructive surgeons, Dr Trishan Pillay and Dr Desigan Pillay.
During the procedure, Dr Baba had to repair and secure the bones using a fixator frame before the plastic and reconstructive surgeons could undertake the free tissue transfer to repair the wound and cover the exposed bone.
Mr Mbuyazi was taken to theatre on the 28th of July for a ‘free anterior lateral thigh flap’ procedure, which involved the transfer of a ‘flap’, or tissue that includes all blood vessels and muscles, from his right thigh to the site of his wound on his left lower leg.
“A flap is tissue that contains its own blood supply and can be composed of skin only, muscle only, or a combination of skin, muscle and bone,” explains Dr Pillay. “As in this case, a flap can be used to close wounds and defects in the body that occur due to trauma or tumour removal.
After the transfer of the tissue, the vessels of the flap were surgically connected to the patient’s anterior tibial artery, the main artery that runs down into the lower leg, as well as to local veins.
“The big difference between normal flaps and the free flap that was used in this case, is that the free flap involves disconnecting the flap with all of its blood vessels from one part of the body and moving it to a completely different site on the body.”
After the procedure and a period of recovery, the patient received rehabilitation, including physiotherapy from the hospital’s physiotherapist, Bhavisha Morar.
“Mr Mbuyazi made a strong recovery and the hospital staff and doctors are gratified that he could be discharged home in good spirits,” says Dr Augusta Dorning, general manager of Netcare Alberlito Hospital and Netcare KwaZulu-Natal region’s business development manager. “His progress will be closely monitored by his team of doctors and we wish him a speedy recovery.”
“The medical team that performed this procedure, including the plastic and reconstructive surgical team of brothers, Dr Trishan Pillay and Dr Desigan Pillay, as well as orthopaedic surgeon Dr Baba, deserve the highest praise. Together they successfully completed what is an extremely intricate procedure requiring the very highest levels of skill.
“It is most gratifying to know that we have the necessary expertise and technology at Netcare Alberlito Hospital to assist our patients who have suffered such complex injury,” concludes Dr Dorning.