>> The threshold for a surgeon to be able to say the leg cannot be saved and this is best treated
with an amputation, is a moving target.
And, you know, that statement is something that has been said for a long time
and it's something that we still say.
There are some legs that we cannot save and are going to be best treated with an amputation.
But the threshold for making that statement really depends on our ability
to perform successful limb salvage.
Go ahead and give it a foot, give it a run.
Like, you know, just like walk, don't hold back.
>> Don't hold back?
>> Don't hold back.
It's pretty strong.
>> I was on my motorcycle with a bunch of friends.
And I lost control the motorcycle and got into a really bad accident, broke almost everything.
>> There you go.
It's great.
You just need to develop a little bit of confidence with it.
>> Yeah.
>> And now--
>> Definitely after three and a half years.
>> Three and a half years being in a wheelchair, it's-- It takes a little time to--
>> [Background Music] I didn't even think I was going to be able to walk this good.
>> You're going to walk better than you are walking now since you get stronger and stronger.
[ Music ]
So the typical patient that we will see somebody who has an infection combined with missing bone
in the leg or the thigh bone, but let's just use the leg as the typical example
because that's the most common situation.
So somebody has a terrible accident.
>> After the accident.
I was in the hospital for four and a half months, which was really tough.
I had a total of 12 surgeries within a month, which was horrible.
I was in ICU for a month.
Left at the hospital, I still didn't even feel like myself probably until a year later.
And then that's actually when I started coming here.
>> He was treated by a colleague of mine in Upstate New York.
And, you know, the guy did all the right things, but unfortunately developed an infection,
which is not uncommon in these kinds of cases.
He had a very severe injury with soft tissue injury.
>> When I initially got into the accident, they thought about the amputation already.
The only reason why they didn't is because I was able to move my toes.
So they kept it but then I kept getting infections because I have a bone infection.
And one of them got treated with the prior doctor, then that's when I came here.
And not that I knew it wasn't going to get amputated
because once I started seeing what goes on here, I knew it wasn't my place.
>> By the time he came to see me, he had an infected nonunion with six inches
of missing bone and additional inch of shortening of the entire leg.
And so what we needed to do was cut out a six inch segment of bone.
We need to lengthen the leg.
We need to reconstruct the bone defect and treat the infection.
And we did that with a technique called trifocal bone transport with an external fixator
that has basically three levels, first floor, second floor, and a third floor.
And there's three things going on, you know, the elevator from the--
The elevator from the third floor is coming down.
The elevator from the first floor is going up until they meet in the middle
and that's how we reconstruct the bone defect.
And then the space, the distraction is all the new bone that grows and it heals.
And I'll show you all these things on the X-rays.
This is a nice picture that really shows the infected dead segment of bone.
You can really see how it demarcates and you can see it almost looks--
it doesn't look quite like normal bone.
And that's what happens when there's an infection
and when there's a dead piece of bone that is in place.
This is a picture of the bone defect.
So this is six inches of missing bone.
This is the top of the tibia.
This is the bottom to tibia.
This is the defect.
And these little pellets are antibiotic pellets that we put in at the time of surgery.
What we're doing here is, this is the knee joint.
This is the bone defect that I showed you.
And we cut the bone here, right?
So we'll call that the third floor.
The second floor is the space is the bone defect.
And the first floor is down by the ankle where we cut the bone.
And so what we're doing is we're lengthening the bone in this direction on the bottom part
to move this piece of bone up to fill in this defect.
We cut the bone over here on the top part of the tibia below the knee to move this piece of bone
down to fill in this bone defect, OK?
That's the idea of bone transport.
So as we're progressing, this is several weeks later, you can see that this piece
of bone is moving down and getting closer.
You see how the defect is actually increasing in size.
So this piece of bone is moving down.
This is new bone.
This piece of bone is moving up.
This is all new bone.
And this is the bone defects that's still there but smaller.
Bone defect was here but no longer is.
Now these two pieces of bone are in contact with each other.
This is all new bone, lengthened bone.
And it looks like there's very little bone in there at this point because it's still immature.
You can see a few weeks later you see how it's progressing.
The calcification of the new bone is improving.
The docking site is progressing.
Further along, you can see the regenerate further improving and calcifying.
Further improving and calcifying, the docking site where the bone defect was is healing
and this is what it looks like when it's all healed when we take the fixator on.
So, again, now you've got knee, ankle.
This is all the new bone that is filled in beautifully.
This is where it docked and is healed.
This was the big defect side.
And this is all new bone that is healed.
And so that's the leg that he can walk on now.
These are some pictures from surgery.
This is the knee.
This is the ankle.
And this is the necrotic piece of bone that we have to excise.
So this is the six inch segment of bone that needed to come out.
This is what the fixator looks like soon after we start the process.
So this is-- The lengthening is happening at this level and this level
and these represents the defect side.
And you'll notice over time, this is going to decrease in size and this
and these are going to increase in size.
This is much further along in the transport process.
And as I promised to show you, this space has increased.
This space has increased and the defect side has decreased
so that corresponds to the progression.
And you can see the process moving along.
[ Music ]
OK. So let's have a look.
The leg looks beautiful.
Look at that, the leg looks beautiful.
>> I mean, I didn't even know places like this existed.
It feels amazing.
It feels like my leg again which it didn't for very long time.
My leg is the same length as the other one now and once again,
I didn't even know that was possible.
You know, you can grow bone or lengthen bones or anything like that.
And now I feel like me.
>> OK. Let's bend your knee.
All right.
Let's plan a great on the floor.
Maybe turn this way.
Good. Turn it back to me.
Yeah, nice alignment.
Leg lengths are equally filled the pelvis height.
That's looks great.
>> The first time I'm standing and you're sitting.
>> Yehey [laughs].
>> I know.
>> Everything is fixed except my left arm.
I have a flexible injury.
And that's going to be worked on in the next couple of months.
And then should be close to 100% [laughs], which I'll take.
I didn't even think I was going to be able to walk again to tell you the truth.
>> These start points, the standpoint that's all new lengthened bone.
This is the docking site.
This is where the nonunion was and the big bone defect.
This is where that six inch defect was that we filled in.
And then all of this is new regenerate bone on the bottom.
It really looks great.
Every time I look at it, the quality of the bone looks better and stronger.
So the chance of, you know, this breaking, the refractured at this point is extremely low.
You'd have to have a pretty bad fall.
>> OK.
>> So I think just walking and using it in a way that feels comfortable for you
and feels natural is quite all right at this point.
>> OK.
>> So I think you're good to, you know, continue walking.
You can kind of-- You can do your thing.
>> Yeah.
>> I'm comfortable with you starting to really walk.
>> Can I wear sneakers outside of the house yet?
>> Yeah.
>> Yeah?
>> Yeah. It's really amazing, you know, to be able to have this kind
of an impact on a patient's life.
This is not about necessarily, you know, just increasing the length of the leg
or correcting the deformity which is incredibly important.
But here, we're really providing a service that is an alternative to amputation.
Part of it is going to be confidence--
>> Definitely.
>> You know, feeling comfortable--
>> Yeah.
>> -- with the idea of doing more.
>> Mentally way more than physical--
>> Right.
>> -- than always.
>> I think that's what's-- These going to have-- there's going to be some of that.
This technology has enabled us to save people's legs.
And the functionality after this is tremendous.
I mean, once the bone is healed, the bone is healed
and you would never even have remembered a year or two out that this person has--
will had this huge bone defect and was a candidate for an amputation.
Any questions for me?
>> No, I mean, therapy, I mean, get to walking [laughs].
>> Therapy--
>> I couldn't be more excited though.
>> Me too.
>> This is amazing.
[ Music ]