Another MD Anderson consult

We are back in Houston to meet with another surgeon who will be part of Alan's team - this time the plastic surgeon who would be doing the reconstruction work. There were two major scenarios we discussed.

First, in the unlikely event that Doc L decides she needs to do a hemi-pelvectomy after all, Doc H's team will be reconstructing Alan's hip. This would involve taking his fibula and using it to bridge the gap, including micro-surgery to attach the blood vessels from the graft bone to his hip. This part of the surgery would take 6-8 hours, but it will be determined early on if it is necessary, so Doc H's team can start in Alan's leg while Doc L and Doc HJ's teams finish with their parts. The blood vessels will need to be closely monitored for the first 48-72 hours after surgery to be sure the blood is flowing through them. This means his recovery would start in the ICU, where the proper monitoring can take place.

Doc H's fellow who went over this procedure with us assured us that losing the fibula would not severely impact Alan's mobility, that it was a common procedure to use that bone in reconstructions. While they do not do many hip reconstructions (about two a month) the blood vessel reattachment is done very often, as is grafting the bone in other parts of the body. The tricky part of this, aside from the fact that Alan is three years old, is that the reconstruction site is inside his abdomen.

The second scenario was the reconstruction of Alan's abdominal wall after the surgery. This would involve using a collagen mesh to prevent a hernia and possibly using one of the abdominal muscles or one of the quadriceps. Since Alan had recovered so quickly from his tumor resection in January, we hadn't realized the extent of reconstruction needed, even without the hemi-pelvectomy. We started thinking about the extent of PT Alan will require after the surgery - he's already lost part of his psoas muscle to the tumor so we were concerned about the impairment of losing quadriceps muscle too, since he has been using them to compensate. However, as Doc H had to point out, we are trying to make the best of a bad situation - this is the cost of going after the tumor more aggressively.