THE St Ann’s Bay Hospital, through its bone transplant programme, has for the past two years been using allografts to provide solutions to very complex situations. So far, the team has performed three such medical procedures, all of which, according to regional consultant orthopaedic surgeon Dr Derrick McDowell, have yielded encouraging results.

“All patients had successful outcomes with good incorporation of bone and soft tissues,” Dr McDowell told the Jamaica Observer in an interview recently.

The three allograft cases included: the treatment of residual diseased bone after successful treatment of chronic osteomyelitis; the treatment of a bone tumour; and the treatment of bone loss after trauma.

“Allograft is transplanting one tissue from a member of one species to another,” McDowell explained. “So, for example, (we could) transplant bone from you to me; that’s an allograft.”

Essentially, it is bone harvested by a tissue bank from a cadaver for use in medical procedures.

“If you had a cancer back in the day, you cut off your foot and cut off your hand, so with a small cancer in the bone, it required a big operation to cut off your hand, cut off your foot to save your life and save your limb,” Dr McDowell told the Sunday Observer. “And I always wondered why we could’t just replace the bone.”

He said when he started working at the St Ann’s Bay Hospital, he met a 16-year-old girl who had cancer in her bone. He decided he was not going to amputate her limb and instead recommended that her mother take her to the United States for treatment. He said it was this young lady that opened his eyes to the possibilities, because when she went for treatment, instead of amputating the limb, the doctors replaced her bone.

He then contacted her doctor in the USA and has since learnt about harvesting bones from dead bodies, how they are processed, and how they are implanted. He explained that once the bones are collected from the dead bodies, they are replaced by broom and mop sticks so as not to disfigure the bodies.

“So I learnt how to clean them up, tidy them up, and make them suitable, check for infections and everything, and then learnt how to process them and how to store them,” McDowell told the Sunday Observer.

According to the orthopaedic surgeon, about eight bone transplants have been done in Jamaica so far, six of which he was involved with and three of which were done at the regional hospital.

The regional hospital’s first case involved a 33-year-old man who suffered chronic osteomyelitis of his right radius when he was eight years old.

“The resultant treatment left him with a malformed forearm with a gap

non-union of the radius and a dysfunctional ulna plus wrist,” McDowell shared, adding that an allograft radius was implanted.

“We had to be able to cut the bone, correct the length, and insert the graft… We basically went in, cut out the bad part of the bone… and stretched the bone out a bit… and replaced the bad bone,” McDowell shared.

The second case involved a 35-year-old woman with a giant cell tumour of the distal femur, which was replaced by a distal femoral allograft implant with reconstruction of the knee joint ligaments.

“This lady had cancer in the bone of the thigh, which is just above the knee. She had a distal tumour, that is a giant cell tumour. The options were to cut it out and fuse it, that is very expensive, (or) the resection and allograft, or do an amputation,” McDowell said.

Instead of amputating her leg, the procedure was

done in July 2013, and since the resection, allograft insertion and soft tissue reconstruction, follow-up

X-rays show healing and a consolidating union site.

A 42-year-old man was the third patient for the programme. He had an open injury and traumatic bone loss to the distal humerus and proximal ulna/radius.

“This one posed the

most challenge,” McDowell disclosed. “It was a policeman who was in an accident and he lost the entire elbow; so he lost the cartilage bone, lost the elbow. When I say lost, it was all mashed up, messed up, full of dirt and everything.

“So we took out all the bones, fixed up the fracture, and he was a candidate now for allograft transplant,” he continued.

The team at the St Ann’s Bay Hospital implanted a distal humeral, proximal ulna/radius, with an intact elbow joint, allograft.

Dr McDowell told the Sunday Observer that the cases are encouraging and show that allograft is an option. But who could be a candidate?

“A person who has a tumour that is localised. If you had a cancer, for example, that has affected the entire leg, that will have to come off. But if you have a tumour that is affecting the bone, which is probably affecting one muscle outside, we can take the bone out so the cancer doesn’t spread to the rest of the body,” the orthopaedic surgeon said. “People (who) have trauma, like the policeman where the bones are mashed up and won’t be able to heal, or bones that heal badly, or like the man who had the infection from eight years old, now there is no longer an infection, but there is a badly deformed limb, are good candidates”

He explained that, unlike other organs, bones are not rejected because the body does not react to say something foreign has been implanted.

He, however, said that two major risks to this medical procedure are infections and the fact that the bone doesn’t heal because it is foreign. He insisted, though, that the programme is doing well.

McDowell also said that, right now, the hospital obtains bones from the tissue bank at the University of Miami, but he did share that they are looking into the possibility of harvesting bones locally. This, he said, will require regulations and laws before it can be realised.

The regional orthopaedic surgeon was quick to point out that the successful cases that have been done at the St Ann’s Bay Hospital simply mean that Jamaica can do it.