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SINGAPORE: Nine-year-old Megan Chew was diagnosed with sarcoma - cancer of the connective tissue or bone - a year ago.
The standard treatment method would have been to cut off the infected bone and replace it with a titanium implant.
But that is likely to leave her with a permanent limp.
A metal piece used for transplants is at least five times heavier than the human bone. While adults can adjust after such an operation, it will be difficult for children.
As the implant wears out in adulthood, she will also have to undergo surgery to replace it.
And since the length of the metal piece is fixed, it means Megan would be at least seven centimetres shorter in one leg.
Hence, instead of standard surgery, her parents opted for a bone graft.
Said assistant professor Suresh Nathan of the department of Orthopaedic Surgery at the Yong Loo Lin School of Medicine: "In this case, the bone was donated from the bone bank in Australia, and we will shape it according to the defect that is there and we will insert it. And then we will fix it with screws and plates in position."
Dr Nathan also stretched the bone during the transplant to compensate for future growth so that at maturity, the two legs will be the same length.
A year after the surgery, Megan can now walk, sometimes without crutches.
Said Maggie Yeo, Megan's mother: "(She's) so much better now. Really so much better. She's able, mobile and happy. Not that she wasn't happy earlier, but she's happy going back to school."
Said Dr Nathan: "The biological technique has that distinct advantage of being durable over a lifetime and not requiring further intervention. The big problem with that is that it's extremely high risk. They are at very high risk of getting infected.
"Now if these things get infected, they get infected in up to 10 per cent of cases and they also fracture in up to 20 per cent of cases. So we really have to develop techniques that will prevent these risks from happening.
For another patient, Dr Nathan grafted the bone from the arm of an adult cadavar onto the legs of a five-year-old child.
The child did not reject the bone and she had normal growth.
The concept of a biological transplant was conceptualised here in Singapore.
Dr Nathan is training other doctors from around the region so that more patients can benefit from the concept.
In Asia, most patients with sarcoma undergo amputation.
- CNA/yb
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