Doctor: Timothy B. Rapp
Specialty: Orthopedic Surgery
Location: NYU Langone Medical Center
Dr. Rapp: Six weeks ago, a 48-year-old limo driver and father of two went to his doctor with ankle pain. Now he’s having his left leg amputated below the knee. He has a soft-tissue sarcoma, a cancer that can occur in connective tissue like bone and cartilage. When people ask what causes these soft sarcoma tumors, I say bad luck. They’re very rare, not associated with smoking or diet, and we don’t really know why one person develops them over another.
For the vast majority of patients, we can treat the tumor while sparing the limb, but this patient had a kind of sarcoma that isn’t sensitive to any radiation or chemo treatments. If we just removed the tumor, there would be a high risk of recurrence.
My goal for this amputation was to avoid leaving the tumor behind but still leave enough muscle and skin to cover the bone. We had to be especially careful to remove enough muscle to be sure we had a wide, clean margin around the tumor. To cut the bone, I used a battery-powered saw. It’s pretty loud. Sounds like a muffled chain saw. When you hold it in your hand, you feel the small vibrations going through your body.
It takes about twenty seconds to go straight through the bone. Then I cut the smaller bone of the leg, the fibula, which takes about five seconds. You complete the amputation by removing the muscle from the back of the bone with an amputation knife. There’s nothing pretty about this procedure—it’s like the Civil War.
At that point, the leg comes off the table. I’ve done hundreds of amputations, and that’s when it always hits me. That’s when I realize I’m taking a part of someone’s body off. It’s brutal, even if it’s the right thing. The patient is healing now, and he’ll have a prosthesis in a few weeks.
As told to Katie Charles.
The patient waits with his wife in the pre-op holding area, where Dr. Rapp will walk them through the surgical process. Photo: Q. Sakamaki/Redux