From Mothers’ Legs, A Second Chance For Children Facing Amputation

Two young boys from Uzbekistan and Tajikistan travelled to Delhi for treatment for bone cancer, hoping to avoid amputation and preserve their ability to walk.

Aged five and 11, both had bone cancer and had been advised to undergo amputation above the knee in their home countries. Their families faced the prospect of fighting a life-threatening illness while also confronting the possibility that the children could lose a limb before they had experienced much of childhood.

However, at Aakash Healthcare Super Speciality Hospital in Dwarka, Delhi, doctors offered them another possibility. They removed the diseased portions of the boys’ thigh bones and reconstructed the defects using sections of the fibula, the smaller bone in each mother’s lower leg.

The surgeries, performed last month, were part of a series of procedures through which the team attempted to preserve limbs in children with extensive bone damage. The approach used a mother’s bone to rebuild her child’s damaged bone, offering a possible alternative in carefully selected cases where conventional reconstruction may be difficult.

The five-year-old from Uzbekistan underwent surgery to remove a malignant tumour from his right femur on September 10. Five days later, the team operated on the 11-year-old boy, who had chondroblastic osteosarcoma near his right knee. His thigh bone was reconstructed using his mother’s fibula and a customised plate.

The procedures have given both children a chance of retaining their limbs. Eventual ability to walk independently, run and participate in everyday activities will depend on bone healing, rehabilitation and long-term follow-up, said Dr Aashish Chaudhary, Director and Head, Orthopaedics and Robotic Joint Replacement, Aakash Healthcare.

He shared how the idea had taken shape in 2021 itself, when they had encountered a difficult case involving an 11-year-old girl from Bihar whose right thigh bone had been severely damaged by a persistent infection.

“She had endured months of pain and undergone multiple operations. The infection had affected such a large portion of her femur, the longest and strongest bone in the body, that removing the diseased bone was necessary. But we deliberated on how to reconstruct her thigh and restore her ability to walk.”

The doctors initially inserted a temporary spacer to maintain the gap between the remaining bone segments and preserve the length of the surrounding soft tissues. After four to six weeks, when the wound had healed and the infection was under control, they reconstructed her femur using a section of her mother’s fibula.

Five years later, her reports reflected that the infection had not returned, and follow-up X-rays showed that the transplanted bone had thickened and adapted to its new role, said Dr Chaudhary. The girl had returned to routine activities, including attending school, and has gradually resumed more demanding physical activities. In 2022, a 14-year-old underwent a similar reconstruction after a chronic femoral infection and a fracture that had failed to heal properly.

Dr Abhishek Kumar Sambharia, Consultant Orthopaedics, Aakash Healthcare, who was part of the operating team with Dr Chaudhary, said the successful cases encouraged them to consider the approach for other children with large bone defects.

“When that first mother offered her bone, we had very little to guide us,” added Dr Chaudhary. “We read everything we could and found it had only been done for the arm. We deliberated if it could work in the leg. When we were presented with other similar cases, we decided the child deserved the chance; otherwise, these children would have been doomed to amputation.”

Since those early operations, four more children from Uzbekistan and Tajikistan have undergone maternal bone graft procedures, including three with cancer.

They include a three-year-old boy from Tajikistan who had completed five cycles of chemotherapy for Ewing’s sarcoma. After removal of the tumour in his right upper arm bone, doctors reconstructed the defect using his mother’s fibula. An Uzbek girl, aged about 11, also underwent reconstruction after doctors removed infected bone and old implants from her left tibia, which had been affected by a congenital condition that had failed to heal.

The two latest cases bring the team’s reported experience with the technique to six children from Central Asia, in addition to the earlier Indian patients.

“A mother's bone does more than fill a gap,” Dr Chaudhry explained, adding that "It is a gift of her own body, and it carries the same biology. What stays with me is the mother asking, before surgery, 'Is my bone strong enough for my child?' Mothers have given these children life once. Here, they helped them walk again.”

In fact, the use of a mother’s fibula to reconstruct a child’s bone defect is unusual, but it is not without precedent in medical literature.

A 2016 case report published in SICOT-J by doctors at the AIIMS, Delhi, described a six-and-a-half-year-old boy with an aneurysmal bone cyst in his right forearm. After removing the lesion, surgeons were left with an 11-cm bone defect. They used a 12-cm segment of his mother’s fibula to reconstruct it.

Radiographs showed that the graft had incorporated into the child’s bone by six months. At the latest follow-up, 24 months after surgery, the child had regained the full range of movement and strength in his elbow. The authors presented the case as a potential option for reconstructing large bone defects in young children.

Similarly, a 2019 study published in the Journal of Plastic, Reconstructive & Aesthetic Surgery examined 27 children who underwent reconstruction with a vascularised fibula flap after removal of bone sarcomas. All but one limb was preserved. However, the overall complication rate was 74.07%, and the fibula fractured in 34.04% of reconstructions. About 79% of the children with 12-month follow-up had achieved full weight-bearing, as per the study.

The findings highlighted both the possibilities and the challenges of limb-sparing surgery: saving a limb does not automatically mean that normal movement will return quickly or without further treatment.

However, published evidence specifically on maternal bone grafting as opted for by the Aakash Healthcare doctors remains limited, claimed Dr Chaudhary.

“The fibula can be used as a graft because the tibia, the stronger bone in the lower leg, bears most of the body's weight,” Dr Sambharia said, adding that however, the amount removed must be carefully planned to minimise the effect on the donor’s leg.

The mother’s recovery is equally important, chipped in by Dr Arun Kumar Giri, Director of Surgical Oncology, at the hospital.

Surgeons must ensure that the donor site heals properly and that removing the bone does not compromise her mobility.

Another consideration is the possibility of an immune reaction. Although mothers and children share genetic material, this does not guarantee tissue compatibility. Dr Giri said the donated bone is cleansed, removing bone marrow and other material from its central canal before using it to reconstruct the child’s damaged bone.

Dr Giri also made it clear that the procedure is not suitable for every child. Doctors must establish whether the entire tumour can be removed, whether enough healthy skin and muscle remain to cover the reconstructed bone, and whether the blood vessels and nerves can support a functional limb. The graft must then unite with the child's existing bone, a process that requires protection, rehabilitation and regular monitoring.

“In cases of cancer, removing the diseased tissue adequately remains essential. Preserving a limb must never come at the cost of effective cancer treatment,” he said.

Dr Chaudhry pointed out that children’s bones have a strong capacity to heal and regenerate. However, the transplanted bone must be protected until it unites with the child’s existing bone, a process that can take six months to a year, he added.