A procedure often used in breast reconstruction surgery was recently performed for the first time at Children’s Healthcare of Atlanta to help a toddler with a birth defect keep moving toward a bright future.
The first decision was the hardest.
Michael Schmitz, MD, Chief of Orthopedics at Children’s, wanted to help Joe, a 2-year-old boy from Liberia, West Africa, who was unable to walk because of a severely deformed right foot. Joe’s foot and lower leg had been damaged since birth, a result of Amniotic Band syndrome, which is a congenital defect that results when a fetus becomes entangled in string-like fibers called amniotic bands that impede the growth of limbs or other parts of a developing baby.
Initially, Dr. Schmitz weighed two key priorities: save the foot, and enable Joe to walk and run. He examined his options, brought in other Children’s specialists and discussed different scenarios of treatment and recovery.
“After several in-depth discussions and much collaboration,” Dr. Schmitz explained, “we decided that the best definitive treatment would mean we would need to reconstruct the limb by amputating the foot; the bone and soft tissue were too involved for a successful limb salvage.” This decision would offer Joe the ability for age-appropriate function.
Through a surgical partnership with Joseph Williams, MD, Chief of Plastic Surgery at Children’s, the team came up with a way to make it easier for Joe to walk with the help of a prosthesis—and not just now, but for the rest of his life.
The solution was a plastic surgery technique often used in flap surgery that allows skin tissue to be placed under the skin to provide both volume and thickness. A typical example of this technique is used during breast reconstruction surgery, where the procedure provides adequate fullness and abdominal wall repairs in the breasts.
“Using this technique for breast reconstructions is fairly common,” said Dr. Schmitz, who is also Co-Director of the Children’s Healthcare of Atlanta Spasticity and Limb Deficiency Clinics. “What was innovative in this case is we were able to take that procedure and use it in a brand new way to help heal and strengthen Joe’s residual limb function and durability.”
In breast reconstruction surgery, the procedure uses soft tissue to restore natural volume in the breasts. But in this case, surgeons used the soft tissue from the amputated foot for padding at the end of the leg. Because the tissue comes from the patient himself, there is less chance of tissue death. “It’s alive and not a graft,” said Dr. Williams.
The soft tissue was not for aesthetic appearance. It was added through this flap procedure and provided critical bulk and volume to handle the wear and tear of a prosthesis and Joe’s continual growth.
Without sufficient natural padding, Joe could possibly have chronic pain from the prosthesis. It could also lead to an open wound or other healing issues. Although the bone in the leg grows slowly, it does continue to grow. Without a buffer over the years, the bone could wear against the skin, becoming a source of constant discomfort and possible infection.
This, Dr. Schmitz said, was a key concern because Joe traveled more than 5,000 miles with his grandmother for medical care. Due to the rigor of their lives, the toddler needed a long-term solution that was going to require very little follow-up medical care. Liberia is a developing country and the family would not be able to get the kind of medical treatment being provided to him here. His mom, still in Liberia, wishes to join her son and mother in the United States one day.
“His mom and grandmother wanted him to walk. That was the No. 1 goal,” Dr. Schmitz said. “We needed a solution where Joe could start reaching normal developmental milestones as quickly as possible.”
Dr. Williams agreed. “We wanted a treatment that would allow Joe to be successful when he returns home. This was the perfect choice.”
And, although the procedure is rooted in plastic surgery, it took a Children’s team of specialists to make sure this case was successful. “This is actually a simple procedure,” Dr. Williams said. “Dr. Schmitz helped make it effective by designing an amazing treatment plan and creating a beautiful flap that allowed me to build in this thick, healthy tissue at the end of the amputation site.”
Now three and a half months post operation, Drs. Schmitz and Williams are pleased with the results. “We’ve got healthy padding that should never get thin,” said Dr. Williams. “This is such a win.”
Richard Welling, MSPO, CPO, Lead Prosthetist, and Colleen Coulter PT, DPT, PhD, Team Lead, Limb Deficiency Program, have also been part of Joe’s specialized team since the beginning. Joe has received his prosthesis and has been cleared by Drs. Schmitz and Williams for walking. The team has been working with Joe and his family and are happy to report that Joe is walking independently, without the use of a walker or crutches. He enjoys playing at the park and loves being able to keep up with the other children.
Dr. Schmitz is so encouraged by the results of this case that he is considering how the application might be replicated for other situations. “This is the wonderful thing about Children’s,” he said. “We have so many pediatric specialists here that we can pull their collective knowledge and skills, and put together a much better outcome for our patients.”
Michael Schmitz, MD, is Co-Medical Director of the Limb Deficiency Program and Chief of Orthopedics at Children’s with expertise in complex spinal deformity, congenital and traumatic limb deficiencies, cerebral palsy and complex fractures.
Joseph Williams, MD, is Chief of Plastic Surgery at Children’s with expertise in cleft lip and palate, craniofacial anomalies, dentofacial anomalies and hemangiomas.
Richard Welling Jr., MSPO, CPO is Lead Prosthetist for the limb deficiency team at Children’s with expertise in upper and lower extremity prosthetics, including the use of microprocessor and myo-electronic controlled devices.
Colleen Coulter PT, DPT, PhD, leads the limb deficiency team at Children’s with expertise in evaluation and treatment of children of all ages with congenital and acquired upper and lower extremity limb deficiencies. Dr. Coulter has expertise in the identification, evaluation and treatment of children diagnosed with congenital muscular torticollis.
This content is general information and not specific medical advice. Always consult with a doctor or healthcare provider if you have any questions or concerns about the health of a child. In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away.