Oishei Children’s Hospital Performs First Free Tissue Transfer on Pediatric Patient
Portion of patient’s leg used to rebuild his jaw after removal of cancer
John R. Oishei Children’s Hospital (OCH) is the first facility in Western New York, and among a few select Children’s hospitals in the country, to successfully transplant a child’s leg bone to rebuild the jaw after removal of cancer.
Thirteen year old TJ Ackley of Alden, NY was diagnosed with neuroblastoma at age five, and was diagnosed a second time in 2018 with metastatic neuroblastoma when doctors found a tumor in his lower jaw. According to the American Cancer Society, neuroblastoma is by far the most common cancer in infants and accounts for approximately 6% of all cancers in children. Thankfully, with some innovative and cutting-edge therapies, TJ’s cancer was controlled; however the cancer remained in his jaw.
Seeking removal of the cancer, a new jaw and a renewed sense of normalcy for their young son, TJ’s parents sought treatment from Michael Markiewicz, DDS, MPH, MD, FACS, professor and chair of the Department of Oral and Maxillofacial Surgery at the University at Buffalo, and co-director of the Laurence C. Wright Craniofacial Center at OCH. It was determined that TJ was a candidate for composite resection of half of his mandible and free fibula flap harvest and transfer with microvascular anastomosis for mandibular reconstruction.
“In basic terms, the procedure involved taking bone from TJ’s lower leg and using innovative computer planning techniques and personalized medicine to reshape the bone to precisely look like his old jaw,” explained Dr. Markiewicz. “Then, under the microscope, using sutures thinner than a human hair, blood vessels of the lower leg bone were connected to those of the neck, making it a living, breathing tissue. So, it was a ‘transplant’ to himself.”
The 10-hour procedure was performed on April 5, 2021 and required a 7-day stay in the ICU.
TJ is now home and back to normal activities.
“He is speaking, eating– and importantly – walking around normally, with little evidence he had a surgery,” said Dr. Markiewicz. “He’s healing incredibly well, and is expected to make a full recovery.”
Eventually, TJ will need to undergo additional surgery to place dental implants into the transplanted bone, giving him a full set of teeth. Once that is done, he’ll be able to eat and chew like a regular kid.
“Right now he’s still on mushy food, so chewing is minimal,” said Kerry Miller, TJ’s mom. “I pureed a steak for him the other night which he loved! But once he receives the dental implants everything will be way better – like it never happened. It’s pretty amazing.”
The road to surgery involved months of preparation, and a multidisciplinary team of specialists from OCH to manage TJ’s chronic medical problems, including his primary pediatric hematologist-oncologist, Meghan Higman, MD, PhD. Roswell Park Comprehensive Cancer Center even jumped on board to collaborate with the surgical team and ensure the best outcomes. Pediatric anesthesiology, speech-language pathology, dentistry, nursing, and critical care teams also played major roles during TJ’s surgery and throughout his recovery.
“It was absolutely a team effort that was precisely orchestrated,” said Dr. Markiewicz. “Practice, preparation, and coordination were key in the success of this procedure.”
Free tissue transfer using the fibula to reconstruct the jaw is commonly done on adults. In fact, hometown hero and Buffalo Bills Hall of Fame quarterback, Jim Kelly, underwent this same procedure at Mount Sinai Hospital in New York City to reconstruct his upper jaw after his own battle with oral cancer.
On May 12, 2021, TJ got the opportunity to personally meet Jim Kelly. They bonded over their experiences with this unique procedure, posed for photos, and compared leg scars.
Fortunately for TJ and his family, they did not have to travel outside of Buffalo to access this extensive and complicated surgery, which is much less common in children, especially those TJ’s age. In his former days as an attending surgeon at the University of Illinois-Chicago and Ann & Robert H. Lurie Children's Hospital of Chicago, Dr. Markiewicz performed several free-tissue transfers on pediatric patients, but none as young as TJ.
“The ability to have this procedure performed here in Buffalo at Oishei Children’s Hospital was amazing,” said Miller. “TJ is just 13, but he’s old enough to know and understand what was going on, and being at Oishei made it easier. It was comforting to see familiar faces and know that we were still home. It also meant that we could remain close to our other children, spouses and extended family – our support system.”
Miller continued, “Everything TJ does, he does with a smile on his face. He’s always telling us ‘I’ve got this’, and he does. He’s definitely our hero. His father calls him his little Superman. TJ kicked cancer’s butt once, and he’ll do it again.”