AR
UR
UAE surgeons have conducted a complex and rare surgery to restore full range of movements to the nearly-paralysed shoulder of a 47-year-old woman. The doctors used decellularised dermal allograft (donor tissue) to treat the patient.
According to reports, decellularised donor grafts are tissues of human skin which are stripped off the DNA of the donor. They can be used in selective cases to avoid any rejection of the graft.
An Indian expat in Abu Dhabi, Bindumol Raman consulted Dr Ravi Kumar Trehan, consultant orthopaedic surgeon and medical director in the Admissions and Transfers section at Sheikh Shakhbout Medical City (SSMC) in May 2021, after he was experiencing severe pain in her right shoulder which resulted in complete immobility.
Recounting the case in an interview with the media, Dr Trehan said that the patient consulted the doctor as she had acute pain and a completely functionless right shoulder. The injury took place when a child pulled at her right hand, causing a massive click on the shoulder. She had a previous injury that had weakened her cuff. However, the new injury made her feel excruciating pain and pseudo paralysis.
The doctor conducted an MRI scan that revealed a significant tear of the rotator cuff and retraction of three of the four tendons in her right shoulder.
“The patient had suffered such a massive and retracted cuff tear that it is usually very difficult to treat. Many such injuries require salvage operations or joint replacement surgeries that severely compromise shoulder function," said Dr Trehan.
Unusual technique
Noting that the patient was young, the doctor decided to save her shoulder joint. While performing a complex reverse geometry joint replacement surgery would have been the conventional choice, the doctor decided against it. Furthermore, the patient had other health issues and had previously undergone thyroidectomy. After four months of delay, Dr Trehan performed the surgery using a decellularised dermal allograft to repair the remaining tendon back on the bone. The doctor was accompanied by orthopaedic surgeons Dr Amin Elhelw and Dr Mahmoud Al Dihy during the surgery.
Dr Trehan explained the decision to use donor dermal graft was taken in view of the massive tear faced by the patient which left nothing in the shoulder to graft.
"Usually, in case of tendon and rotator cuff injuries, a patient’s own tissue graft can be sutured for it to regenerate and heal. However, in this case, the patient had such a massive tear that there was nothing left in the shoulder to graft. Therefore, we decided to use an allograft to repair," Dr Trehan added.
What is a decellularised graft?
Dr Trehan further elaborated that an auto graft (tissue from patient’s own tendon) is usually used to repair such injuries. However, in this case, there was literally a hole in the patient's tendon, as the tear was massive.
"Therefore, there was no question of using her own tissue. In this case, we used a decellularised tendon graft, which means it was stripped off, of any vestiges of the DNA of the donor," Dr Trehan said.
The process made it non-immunogenic by eliminating the chances of rejection. The medical team only retained the graft with its biomechanical properties or as a mere scaffolding to bridge that hole. Once the tissue will integrate, the cells of the patient will start growing on it.
Restoration of full functions
About four months after the surgery, the patient was discharged, following which she retained full functioning of her shoulder and had zero pain.
Since her discharge, Raman is doing well and living as usual. She further expressed her gratitude to the medical team who treated her.
“Thank you for the exceptional surgery through which I have got back my normal life. My hand was totally inactive prior to the surgery. Now I can move it perfectly and conduct all daily activities," she wrote in a letter to the hospital.