Page 63 - MASALA Magazine Vol.15 Issue 7 | October - November 2024

A VALUABLE CASE STUDY

“The doctor who oversaw the care of this female patient from
Myanmar was “Chindanai Hongsaprabhas, M.D., a surgeon
specializing in tumors and cancers of the bones and related
tissues”. He provided insights that contribute to a valuable “case
study” for a condition that is not commonly encountered. Our
team spoke to “Dr. Chindanai” about the medical case, where
he concluded...
“...The patient is from Myanmar and received treatment there
approximately 20 years ago for a tumor in her left leg. She underwent
surgery 17 years ago when the tumor measured 20-30 centimeters,
as per the doctor’s ndings, indicating it was a simple liposarcoma. ASST. PROF. DR. CHINDANAI

However, after the initial surgery, a new tumor began to grow DR. SUTHAS HORSIRIMANONT HONGSAPRABHAS
again. The patient left it untreated until it reached a signi cant

size of about 30-40 centimeters, eventually impacting her daily life. we discussed the various risks with Dr. Chindanai and explained
Upon consulting a doctor in Myanmar, she underwent an X-ray to the patient the likelihood of successfully removing the tumor
and biopsy, which revealed it was a low-grade cancer. The doctor completely. However, it may be necessary to excise this group of
advised that surgery would be challenging, and the only viable blood vessels, including the small branches in the surrounding area,

option would be to amputate the leg. The patient was shocked by which could result in diminished blood ow to the leg. To prioritize
the diagnosis and decided to seek a second opinion at Sukumvit the patient’s safety, we must perform a vascular reconstruction,
Hospital, eventually scheduling treatment there...An MRI revealed commonly referred to as bypass surgery. This procedure is akin
a very large liposarcoma in the leg, with cross-sectional images to rerouting a road; it is essential to ensure that the source blood
showing that the tumor occupied nearly 70 to 80% of the leg. Upon vessel remains functional and unobstructed, while the destination

reviewing the MRI, it was alarming to see that the major blood vessel must be accessible and of suf cient size... The treatment’s
vessel supplying the inner part of the leg had been encroached upon outcome was quite favorable. Following the bypass procedure, blood

by the tumor. This made surgery complex, as removing the blood ow to the leg showed signi cant improvement starting from the

vessel could...necessitate partial leg amputation...Therefore, it was rst day post-surgery. Previously, the pulse in the patient’s foot was
essential to involve two specialized medical teams in the surgical undetectable; however, it became palpable again after the bypass
plan. My team focused on removing the tumor rst, followed was completed, and the leg felt warm almost immediately. Overall,

by Asst. Prof. Dr. Suthas’ team, who would reconnect the blood all conditions remained stable, and there was adequate blood

vessel. Afterward, I would evaluate the situation and determine if supply...This case could be classi ed as a complex treatment that
a metal implant was required for the bone. The surgery took about necessitated collaborative care from both Dr. Chindanai’s team and
six hours and was completed successfully...” the internal medicine team to manage various risks and monitor
the patient post-surgery. Given that this was a major operation,
Approximately seven days after the surgery, the patient was able there was considerable blood loss, requiring close surveillance of
to walk with the assistance of a walker, showing promising results. vital signs, wound care, and the patient’s overall condition. It was
If the wound is properly cared for and heals well, and she can walk crucial to assemble a multidisciplinary team for comprehensive
steadily, she will be able to begin physical therapy to strengthen the care. The patient needed to remain in the ICU for approximately
remaining muscles, compensating for the part that was removed. 1-2 days, and once stable, could be transferred to a regular ward for
I believe that with this approach, she should regain near-normal ongoing monitoring until she was prepared for discharge.”
function within 2-3 weeks post-surgery.
This Wednesday, on “Comfort...Near Doctors”, will showcase a
case study on this patient’s condition to highlight the advancements in

AN OVERVIEW OF VASCULAR BYPASS SURGERY the medical eld in Thailand, which is equipped with the technology
needed to treat patients and alleviate their pain from various diseases,
FOR THE LEG... including “complex conditions” that nearly led to the unexpected
loss of a limb for a patient from our neighboring country.
Let’s continue with “Chindanai Hongsaprabhas, M.D., a
surgeon specializing in tumors and cancers of the bones and
related tissues” as he explains how the surgery for this patient SUKUMVIT HOSPITAL
necessitated collaboration between two medical teams during the 1411 Sukhumvit Road
planning phase. It was clari ed that ‘Asst. Prof. Dr. Suthats’ team (Ekkamai BTS)

was tasked with “reconnecting the blood vessel” after the tumor Prakanong Nua, Wattana,
was surgically removed as the initial step. “Dr. Jor Kaew” believes Bangkok, Thailand 10110

readers will be interested in the speci cs of this process. Please stay Tel: 02 391 0011
tuned for insights from “Asst. Prof. Dr. Suthas Horsirimanont, Email:
a specialist in vascular surgery”,who serves as a “consulting info@sukumvithospital.com
physician at Sukumvit Hospital.”
www.sukumvithospital.com
“...We carried out a comprehensive examination, and most
importantly, we performed a CT scan to evaluate the tumor’s size
and examine the blood vessels supplying it, including those leading
to the foot. Our ndings revealed that this critical blood vessel was

compressed by the tumor and had become blocked. Consequently,