Bone tumours are rare. But a few are aggressive, and when they relapse in difficult anatomy, limb salvage becomes a team sport — imaging, surgery, microvascular reconstruction and the patient’s own courage, all pulling in the same direction.
The patient who walked in with a limp
In 2017, a 2nd-year civil engineering student from Goa — we’ll call him Ganesh — walked into the clinic with a visibly painful limp. His lower leg and ankle were swollen, with angry blue-green veins coursing along the skin. Every step made him wince. An old surgical scar had opened up into an ulcer that was discharging pus.
Ganesh had already been through two surgeries for a bone tumour at different hospitals — the first in 2012, and another for recurrence in 2014. He had come to us carrying not just disease, but years of fear and fatigue.
Untangling infection from recurrence
Multiple scans were done to tease apart the two possibilities — was this infection alone, or was the tumour back? A biopsy confirmed our suspicion: the giant cell tumour had relapsed, and the situation was complicated by a stubborn superbug (Acinetobacter) sitting on top of it.
His family told us, with quiet pain, that another team had advised amputation the day the pus started pouring. They had held on, hoping antibiotics alone would turn things around. By the time they reached us, the conventional answer was indeed amputation below the knee — and on paper, that would have been the safer, faster path to rehabilitation.
Why the distal tibia is so unforgiving
Tumours around the lower leg and ankle are some of the hardest limb-salvage situations in our practice. The distal tibia has an inherently fragile blood supply. Here, the tumour had destroyed both the tibia and the fibula around the ankle, infection had taken root, and the soft-tissue envelope over the bone was thin and scarred from previous surgeries.
Any plan had to do three things at once: clear the disease completely, keep the bone–implant–soft tissue construct alive long enough to heal, and give him an ankle he could actually walk on. That meant a staged, multi-team approach — and the honest possibility that we could still save the limb.
9th September 2017 — 15 hours in the OR
One could be forgiven for assuming a trip to Goa meant a holiday. Instead, at 7 a.m. on 9th September 2017, we were wheeling Ganesh into theatre for limb-saving surgery. The plan, executed step by step, involved:
- Wide, en-bloc removal of the recurrent tumour
- Reconstruction of the leg and ankle with our “desi jugaad” nail–plate–cement spacer construct
- Microvascular free-flap cover — skin and muscle harvested from the thigh, with its own intact blood supply, to resurface the area
The team for the day included an orthopaedic oncologist, a senior orthopaedic surgeon and a microvascular-reconstructive surgeon. Ganesh’s “surgical ordeal” ended around 10 p.m. — about fifteen hours after we began. The first time he saw his toes wiggle under the plaster, that quiet, exhausted smile said everything.
The calm after the storm
Recovery was, mercifully, uneventful. His family stood beside him through every dressing change; the rehab team pushed him just hard enough to rebuild belief in his own leg. We were deliberately aggressive with mobilisation — he needed to feel, early, that walking well again was not a hope, it was a plan.
The final histopathology of the removed specimen confirmed what we had been hoping for: the tumour was out, in one piece, with no spillage.
Seven and a half years on
Today, Ganesh is a practising civil engineer. He walks his own project sites — both feet firmly on the ground — and somewhere in those building plans is, quietly, the case for never giving up on a limb too soon.
Imaging, oncology, ortho and microvascular surgery — aligned before the first incision.
Staged limb-salvage where amputation had been advised elsewhere.
Disease-free, walking project sites and back to a working life.
This article is a surgeon’s personal account of one patient’s journey, shared for educational and awareness purposes. The patient’s name and identifying details have been changed. Outcomes vary from person to person, and the treatment described here was tailored to this specific case. Nothing in this story constitutes medical advice or a guarantee of similar results. Please consult a qualified specialist before making any decision about your own care.