- 6 days ago
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00:00Hello, mate. You understand Irish?
00:02Animals from all over the world
00:04Ah, bonjour!
00:06Come to see one extraordinary man
00:08who's known as the Bionic Vet.
00:10High five!
00:12Yes!
00:14Professor Noel Fitzpatrick
00:16We only get one shot at this. Here we go.
00:18Noel and his team offer
00:20some of the most advanced treatments available
00:22anywhere. The perfect marriage
00:24of mechanics and biology.
00:26This is what we have now. A brand new knee.
00:28Oh, wow!
00:30For some, it's a
00:32last chance. It is a life or
00:34death situation because we cannot leave him
00:36like he is. I just want you to do
00:38anything you can for him, really.
00:40Sorry. As Noel
00:42continues to devise new ways of
00:44healing... You're going to be my own.
00:46Thank you so much. All good. All good.
00:48...he transforms the lives of his patients.
00:50Oh, that is just unbelievable.
00:52He's raring to go.
00:54...against all the odds. Boom!
00:56One small step for a dog, one giant leap
00:58from mankind. Well done.
01:08It's mid-morning at
01:10Fitzpatrick Referrals' sister
01:12clinic in Guildford.
01:14Hello, kitty.
01:16One year old Persian cat has been brought in
01:18after being hit by a car.
01:20He's a nice cat.
01:22He's a super nice cat. Simba.
01:24Do you reckon he was named after the Lion King?
01:26Hello.
01:28One of Noel's team,
01:30reconstructive surgical specialist Dr Jonathan Bray,
01:32is assessing his injuries.
01:34So Simba was hit by a car two days ago.
01:38Quite bad injuries to both front legs.
01:40He's lost most of the skin and there's some fractures.
01:46We are worried about blood supply to the foot.
01:48So before we anaesthetise,
01:50I'm trying to get access to her toes
01:52so that I can check her sensation.
01:58Good kitty.
02:00Do you want to come and get hot chocolate?
02:02Do you want to get hot chocolate with me?
02:04Come on, help me.
02:06Come on.
02:08The cat is a therapy cat for 11-year-old Kian,
02:10who is autistic.
02:12If Kian's having a really, really bad day
02:14with his autism and the meltdown quite badly,
02:18Simba will lay on his head
02:20or if Kian is hurting himself,
02:22Simba puts his paws on his hands
02:24and he just goes everywhere with him
02:28and Kian won't allow us anywhere near him some days.
02:32But who are you now near you?
02:34Simba.
02:36What does Simba do for you?
02:38It makes you feel happy.
02:40After the accident,
02:42Simba was taken to his local vet
02:44for emergency treatment.
02:46It became apparent that actually
02:48with the injuries to both legs
02:50that they didn't think
02:52that they'd be able to save him.
02:54And they brought Simba in to say goodbye.
02:58At which point Kian
03:00obviously got very, very upset.
03:02Simba has substantial fractures in his right foot
03:06and the skin has been ripped off his left leg.
03:08We'll just see what's going on.
03:10The family have brought Simba to Fitzpatrick's
03:12as their last hope.
03:14He has got a chance here.
03:16Even if he loses a leg and a foot,
03:18he has still got a chance.
03:20And that's huge.
03:22So grab a seat.
03:24So we've got some injuries.
03:26Time will tell.
03:28Okay.
03:30Left side is the worst
03:32from a skin damage point of view.
03:34This side, honestly don't know.
03:36At worst, we might loosen toes.
03:38Okay.
03:40I get a sense that the leg is intact and moving freely.
03:42Again, we'll assess that as he's up and about
03:44and moving around.
03:46But no, amputation's not on the list at the moment.
03:48Okay.
03:49That's incredible.
03:50So we'll see.
03:51All right.
03:52I'll leave you to go home.
03:54Okay.
03:55Talk to you, Mike.
03:56See you later.
03:57The news comes as a huge relief for the family.
04:00Simba will be clear to the family.
04:02The family is a huge relief for the family.
04:05The family is a huge relief for the family.
04:08Simba will be closely monitored over the next few days
04:12to see if the wound can support a skin graft
04:14and whether it's possible to reconstruct his crushed foot.
04:21I'm being told he's going to have no legs to this.
04:24So he's definitely going to live?
04:26Yes, darling.
04:28I might even keep both legs.
04:38It's an unusually quiet reception this morning
04:42at Fitzpatrick Referrals' main headquarters.
04:45But even in a crowd, there's something about Noel's next patient
04:49that stands out.
04:51He definitely has a bit of a large tongue.
04:55He sticks out all the time, constantly.
04:57He's not being rude.
04:58His tongue is too big for his mouth, basically.
05:01It doesn't do any harm whatsoever, but he looks cute.
05:04100% of the time.
05:06Where's your tongue gone?
05:08My name's Melissa and I have an addiction.
05:15You all right, Snora?
05:17Good boy, Tiny.
05:19Two-year-old Staffy Cross Tiny lives with Melissa and her family.
05:23Come on, then. Presents.
05:25Sit.
05:26My addiction is I rescue dogs and rehome them, rehabilitate them
05:31with behavioural problems.
05:32Will you get down, please?
05:34We don't get anything if we jump up, do we?
05:36And send them packing, hopefully, to a really lovely forever home.
05:40Right, one more, no more.
05:42The most amount of dogs that I've had in one go was 21 dogs.
05:50And it was hellish.
05:51Melissa began fostering dogs four years ago
05:54after suffering a brutal attack while on holiday in Spain.
05:58When I came home, it was quite a horrible recovery.
06:01And I was giving up a little bit, to be honest with you.
06:05And then Tiny's litter turned up on the doorstep.
06:11He was the ugliest puppy I've ever seen in all my days.
06:15He had a forehead that we didn't think he'd ever grow into.
06:19Thankfully, he's grown into a swan.
06:22Tiny.
06:23He brought me back from despair.
06:29I'd given up.
06:30I was able to care for somebody else.
06:33That gave me strength.
06:34He reminded me who I was when I couldn't remember.
06:38And that's a really special gift to give.
06:44Sadly, Tiny has started suffering from problems of his own.
06:48We'd go out on walks and then he'd have a bit of a limp when he came home.
06:52The vet suggested that it was elbow dysplasia.
06:56I hope that I can do for him as he's done for me.
07:00Because I don't want my boy in pain anymore.
07:02No, Tiny, please, Tiny.
07:03What do you know about elbow disease already?
07:04Um, absolutely nothing.
07:05OK.
07:06Well, that makes it easy.
07:07We can start at the beginning.
07:08That should be a nice fit.
07:09So if that's an arse and that's a saddle, basically the arse doesn't fit the saddle.
07:23Yeah.
07:24In layman's terms.
07:26So there's too much pressure going down through there and that cracks and rubs away.
07:32So almost certainly if we stuck the camera in there, we would see that there's no cartilage between there and there.
07:39What's the plan?
07:40So the plan is we take a CT scan to see how much bone is rubbed.
07:46And then we do an arthroscopy to see how much cartilage is gone.
07:50Right.
07:51Depending on what the camera inserted in the elbow shows, Tiny could have painkillers or injections.
07:57But it's possible that surgery may give him a more lasting relief from pain.
08:02Option one is osteotomy, which is to unload it and shift weight to the other side.
08:07Yeah.
08:08Option two is partial, complete joint replacement, in this case probably partial.
08:12Righto.
08:13Um, and would that be both of them?
08:15I suspect both of them, yeah.
08:17Right.
08:18Every surgery has risk.
08:20He could have an infection.
08:21The bone might not heal right.
08:22Yeah.
08:23But at the end of the day, you're trying to do the right thing and get your dog out of pain.
08:26Yeah.
08:27He means the world to me.
08:28So whatever you need to do to make him as happy as he can possibly be is what I'd like you to do.
08:34Understood.
08:35Okay.
08:36Do you know how much trouble you're worth?
08:39All he's concerned is whether mummy gives him a big cuddle or not.
08:41Yeah.
08:42Yeah.
08:43Thanks.
08:47Okay, my love.
08:48Um.
08:49Oh, his elbows are screwed.
08:53Oh, to put it bluntly.
08:55We're in good hands.
08:56Yeah.
08:57Yeah.
08:58It'll be the first night I've been away from him.
09:04But you know, he's a good boy.
09:05He'll be all right.
09:06He's a bruiser.
09:07He's brave.
09:08Um, but I'm looking forward to getting him home whenever that is.
09:14The arthroscopy will help Noel decide the best course of action for Tiny's elbows.
09:19As we move the joint, you can see where the humerus is rubbing against the ulna all of the time.
09:27And that's what causes the erosion.
09:29You can see here, there's some raw bone.
09:32Cartilage is completely gone.
09:34And if we stick a needle into it just to show how hard it is, because it's rock hard.
09:39The inside of the joint is trashed, but the outside of the joint actually still seems to have cartilage on it.
09:48So that's a little beacon of light, all that there.
09:53So, uh, it's a difficult situation because he's badly affected on both sides.
09:59The thing is that Tiny is, uh, is only two years of age.
10:03I'm a little worried how an artificial joint's gonna hold up over time.
10:07It's difficult.
10:10This is a difficult challenge.
10:18So at the moment, what's going on in my head is that if I did an unloading osteotomy,
10:22then the body weight will go down through the outside of the joint, which is still okay,
10:26giving the inside of the joint a chance to recover, uh, and to not get bad as quickly.
10:32Tiny will have surgery to give him a chance of a future.
10:36That's pain-free.
10:39All right, mate. We'll come back another day and try and fix you.
10:43Hey, buddy. How you doing?
10:45Hi, mate. How are you today?
10:48Ten days ago, Simba the therapy cat was hit by a car, badly injuring both of his front legs.
11:03So it looks rather angry, don't you think?
11:06Surgeon Jonathan has been checking his skin regularly, and Noel has come to assess the damage to his front right paw.
11:18John is gonna do some skin grafting on one front leg to try and get that healing.
11:25And he wants me to try and fix the fractured fingers on the other front leg.
11:31Hmm. It's gonna be challenging. You all right, buddy?
11:35Oh, yeah. Now you want cuddles. Oh, yeah. Now you want cuddles.
11:43This is the first time 11-year-old Kian has spent any time apart from Simba, who helps him cope with his autism.
11:50You wait till he sees you. He'll be climbing out of that basket.
11:56Hey, guys. How are you?
11:58Hello.
11:59Today, the family are meeting Noel to discuss surgery for Simba.
12:03I'm Annette. Annette. My mum.
12:05Hi, Becky. Hello, mate. How are you? Nice shirt. I've got a shirt like that, too. What's your name?
12:10Kian. And this is your friend, I believe, to help you through the difficult patches. Is that right?
12:15He's actually... I've never come across a cat that does what he does.
12:19And what does he do then?
12:20So, when Kian was little, his lungs didn't work, and he would just stop breathing out of it.
12:25He could be eating, sleeping, and just his lungs would just stop, and we'd just flatline.
12:29But Simba learnt that when it was gonna happen.
12:32So, he would tell mum when your lungs were gonna stop. That's amazing. How old is Simba now?
12:36Seven. Seven.
12:37But he does different things for you now, doesn't he? What does he do now when you're poorly?
12:41He just comes up and starts rubbing his head on me.
12:44Oh, wow. Well, I'm sorry to hear you have such tough patches, but...
12:48It's wonderful that you found a little companion to help you.
12:51And I just hope that we can get Simba through this.
12:53I'm gonna sit with you, actually, because I want you to be strong for him.
12:57Now, he needs you as much as you've needed him.
13:00Now, have you ever seen the movie character Wolverine?
13:04Yeah.
13:05Ah, there you go. Did you see that boom of light? Boom. Boom. That's right. That's it. Yes.
13:13So, what does he have coming out of there?
13:15Um...
13:16Adamantium.
13:17Adamantium.
13:18Exactly, my friend. He's all over this. You and me are gonna be best friends.
13:23He has Adamantium pegs coming out of here.
13:26So, I saw that movie years ago, the very first one, long before you were born.
13:31And I was captivated by that. Couldn't find Adamantium anywhere on planet Earth.
13:36So, I had to go to a different...
13:37It's only a fictional metal. It's actually real.
13:38I love that. You're absolutely right. It's only a fictional metal. It's not actually real.
13:47So, we're gonna have to make do with what we've got for now, which is stainless steel pegs.
13:51If, if we were able to put Wolverine's pegs up along the bonds, then even if this bit was tiny and short,
14:01we could potentially skewer it in position like so, couldn't we?
14:06How long have you been doing this for?
14:08Me? Oh, good. Now we're getting the grilling on qualifications.
14:12A long time. I'm actually not particularly bright.
14:15I found exams very difficult. I'm not particularly good at anything.
14:20Except trying to think of a way around problems.
14:23And when I see a frustrating problem, like the problem that Simba has now,
14:28I always think, well, why can't we do better than that?
14:31What do you say to Noel for accepting it?
14:33No, no, no, you're very, listen, mate, it's my entire pleasure.
14:36Can we have a hug? Well done, mate.
14:38Oh, you're such a good boy.
14:39You're such a good boy. Thank you so much.
14:42I'll get him for you.
14:44All right. And keep the faith.
14:46You're a good kid. You really are.
14:47Have I got a key fob?
14:48Have you got a key fob?
14:49Has anyone got a key fob?
14:51Are we locked in forever?
14:52We just have to consider what the implications of inventing stuff here forever is.
14:58We might go out this way.
15:01OK.
15:02Hello, gorgeous boy.
15:04There we go.
15:05Sam's been looking after Simba.
15:07Now, mate, look who's here.
15:09All right, buddy.
15:10If you stand up, Cian, and just hold it.
15:13Lift this.
15:14There you go.
15:15Now.
15:16There you are.
15:17Look who's here, Simbas.
15:18There you go.
15:19There you go.
15:20Good.
15:21Aw.
15:22I'm not a family bad boy.
15:23Aw, that's lucky.
15:25The family have decided Simba will undergo surgery in about a week.
15:30But for now, they can spend some precious time with him.
15:33Hello.
15:34Yeah.
15:35You're a little star, aren't you?
15:38That's what it is.
15:40So happy.
15:41Happy.
15:51Whilst Noel's Cancer and Soft Tissue Centre is on a separate site from his orthopaedics and neurosurgery practice,
15:58the clinicians work together closely every day.
16:02Gone are the days where an individual vet can do everything.
16:07So treat the belly as well as the brain, as well as a fracture.
16:11That's no longer the case.
16:12That is why I've built a team of people that can do what I can't do.
16:17In other words, individuals who are extraordinarily good at the specific area they work in.
16:25Every week, the entire team assembles to discuss cases.
16:29It allows us to bring our specialists in soft tissue surgery together with our specialists in orthopaedics
16:35to try and make the best decisions possible for our patients.
16:39OK, next stop.
16:41Today, they are considering treatment for a four-year-old lurcher called Cato,
16:46who has a cancerous tumour in his jaw.
16:48The dog is bright and happy, unbothered by the mass, but he's got a small cocktail-sausage-sized mass,
16:57just the base of the mandible.
17:00Cato's local vet attempted to remove the tumour, but it returned.
17:04His remaining option now is to have half his lower jaw cut away,
17:08unless the team can come up with another solution.
17:11So, I talked about options and said we need to know just how extensive this tumour is.
17:19Well, the other two options, you just chop the entire mandible out or replace it.
17:25Yeah.
17:26We talked about an implant and explained that that's reasonably new technology,
17:32but they were interested in trying.
17:34The dog is young, so I think it would be a perfect candidate for an implant.
17:38A 3D-printed jaw implant could offer Cato a chance of a normal life.
17:47One week later, and Cato is back with Beverley and John to discuss the surgery.
17:53The family rescued Cato three years ago.
17:56When we first got him, he was very, very nervous.
17:59I think he'd been mistreated.
18:00He was a stray, so he was quite thin, and he looked like he'd been fending for himself.
18:06We would call him a dustbin dog. He'd eat anything and everything.
18:09He's a little more discerning palate now, but...
18:13The really funny thing is he absolutely loves bin men.
18:17He gets really excited, and our bin men come and fuss him on Friday.
18:21And I just wonder whether, when he was a stray, perhaps the bin men fed him or something.
18:26I don't know, but he's just got a real affinity to bin men.
18:29So, are you going to be brave?
18:32We understand that if they have the jaw removed, you may have to hand feed them,
18:38because obviously they don't have the same function.
18:41And Cato loves playing with a stick and a ball and playing with his toys,
18:45so the option of having an implant would mean he'll still be able to do those things.
18:51But before the implant surgery can go ahead, Noel needs to address a concern.
18:56So there's a possibility that the tumour comes from a nerve.
19:00The jawbone, the mandible, has a hole in it here through which a big nerve and some blood vessels go.
19:06It may be possible to actually get rid of the tumour forever.
19:10But if the tumour tracks along the nerve and is going further up from here,
19:16towards the back of the mouth, that's not possible.
19:23Cato will need an MRI scan to determine the extent of the tumour's spread.
19:32Right, what have we got?
19:36Wow.
19:37I'm worried now because that tumour is growing towards the other side.
19:42That's not good.
19:43Okay, thanks.
19:47There's good and bad news.
19:48The good news is it's still very localised and we cannot see it tracking up the nerve.
19:53Okay.
19:54The bad news is it's touching the other mandible.
19:56Okay.
19:57Which you can see there.
20:01There's a small line of grey between it and the other jaw,
20:04so I'm going to need to consult with John and the radiologist
20:07to determine whether he thinks that's enough margin.
20:11Couldn't that just be touching?
20:13Yes.
20:14And then you take it away, it just peels away.
20:16But I want John to say, because it's just touching,
20:21will it leave cells on that that could come back?
20:24Yeah.
20:25Yeah.
20:26We have to be as confident as humanly possible that we get all this humour out.
20:29Otherwise it's all for nothing.
20:30For now, Kato must return home.
20:31Got something nice for you.
20:32Want some fish skin?
20:33To wait and see if he can have the operation.
20:37Tiny and his overlong tongue are back at Fitzpatrick's.
20:40Wow!
20:41See!
20:42Melissa has asked Noel to go ahead and perform the surgery,
20:46which will hopefully treat his painful elbows.
20:49Today, we're in for him to have his elbow done, his left elbow,
20:52and we're going to have to go ahead and perform the surgery,
20:56which will hopefully treat his painful elbows.
21:01Today we're in for him to have his elbow done, his left elbow.
21:09And they're going to break his poor little leg.
21:12And then they're going to put a plate in which will reposition the weight
21:17and put the pressure on his good side rather than his bad side,
21:22and stay in shape.
21:24And then they're going to put a plate in which will reposition the weight
21:26and put the pressure on his good side rather than his bad side,
21:30and stage two will be the other leg in four weeks' time.
21:41Tiny is aptly named because he has tiny bones
21:44relative to his body size.
21:46So we've got a specifically made plate
21:48which should accurately fit the contours of the bone
21:53when we go in here.
21:54A lot depends on what this fella here does.
21:57He supports the leg so it doesn't rotate downwards and upwards.
22:01So basically, if this goes wrong, it's entirely your fault.
22:06No, I'm joking.
22:09Primary surgeon always takes the blame, man.
22:12Have you got the implant for me, please?
22:15This is the plate.
22:16It's shaped like a hockey stick, as you can see,
22:18with a step in the middle there.
22:20The underside is flat, so we have to be very careful
22:22how we position it.
22:23If you get that wrong, you get everything wrong.
22:26Just hold it.
22:30Noel needs to screw the top section of the plate
22:33into position on the humerus
22:35before he can cut through the bone.
22:42I'm not happy with that.
22:44It's going to have to rotate a bit more.
22:47Wow.
22:48It's proving very difficult to get this centered
22:50on this short, stubby bone.
22:52OK, hold that again.
22:56Normally, the humerus is like an oval in cross-section.
22:58This one's triangular.
23:00And the apex of the triangle is right under the plate.
23:05Don't go down.
23:06Don't go down.
23:07Pull.
23:08Let me treble check that.
23:09Relax.
23:12Still not happy.
23:14It's very annoying.
23:15OK, I saw it's in the right position.
23:25We've locked the top part of the plate down onto the bone.
23:28We're now going to saw the bone in half.
23:29So as we tighten these screws,
23:39the bottom segment, let go, let go.
23:41The bottom segment should just slide up towards the plate,
23:45creating a step
23:47so the body weight's going to go down through the outside.
23:51Noel packs in donor bone graft
23:54to form a scaffolding
23:55into which he hopes new bone will grow.
23:58And this bone graft was donated from a deceased dog,
24:01the same as you or me can donate parts of our body when we die.
24:05I think it's a good thing.
24:07I think that every dog should carry a donor card.
24:09When I'm dead, certainly,
24:11the living are very welcome to parts of my body.
24:13That's for sure.
24:15All right, let's go to X-ray.
24:20Hello?
24:20Hey, Melissa, it's Noel. How are you doing?
24:22Hiya, Noel. How are you doing?
24:23Good, thank you.
24:24Everything went fine with Tiny.
24:26Oh, superb.
24:27A bit tricky in the middle,
24:29but the plate on the post-op X-ray picture looks good.
24:32Done me proud.
24:33Well, we don't know yet.
24:34We've got still another leg to go,
24:37but hopefully this one will heal well.
24:39Okay, darling.
24:40Thank you so much.
24:41My pleasure.
24:42Have a good night's sleep,
24:44and thank you so much for looking after my boy.
24:47You're a nice girl.
24:48Not many people thank me as effusively,
24:50so thank you very much.
24:52Okay, you take care.
24:53Take care.
24:54Talk to you tomorrow.
24:55All right, bye.
24:55Okay, bye.
24:56Bye.
24:57What a lovely girl.
25:03Good boy.
25:04Three weeks ago, a car accident ripped off
25:09most of the skin from Simba's left front leg,
25:12leaving him in too much pain to walk.
25:15Finally got Simba's wound to a point where I'm happy
25:18with how the surface is to support a skin graft.
25:22So we're going to put what we call a free skin graft on the area today.
25:27So that involves lifting off some skin on the chest wall,
25:33dissecting free all of the fat,
25:35and all of the non-skin tissue.
25:41So we're really just left with a thin wafer of skin.
25:46Jonathan then makes holes in the skin like a pie crust
25:49to allow moisture out
25:51and to give it the flexibility to wrap to the contours of the leg.
25:55We'll put quite a series of stitches all the way around the outside.
25:59Yeah, movement is what kills us.
26:03The graft is secured in place,
26:05making sure the hair follicles will grow in the right direction,
26:08and then it's up to nature to take its course.
26:12Fluid and plasma literally moves from the body into the skin,
26:17and that's how the skin cells get their nutrients
26:19over the next two or three days.
26:21And as long as that's allowed to happen
26:24and it doesn't move, it doesn't get disturbed,
26:27then the skin cells will survive,
26:29they'll make a happy home for themselves,
26:31and it just becomes integrated.
26:34That looks lovely.
26:38OK, rest is down to you, little Simba.
26:43There you go.
26:48Oh, sweet.
26:51Bye-bye.
27:02Sit.
27:03Right, don't have my fingers, thank you.
27:06Oi, oi, oi, oi, oi, oi.
27:08Don't get all worked up, sunshine.
27:11Kato, the ever-hungry lurcher,
27:13has arrived for the surgery on his jaw.
27:16Because he's under the anaesthetic,
27:18he couldn't have any breakfast,
27:19so we treed him to a late supper last night.
27:23He had some roast beef.
27:25Which didn't last very long, did it, Kato?
27:28After examining Kato's MRI scan,
27:30Jonathan and Noel feel they have a good chance
27:33of completely removing the cancerous tumour.
27:35You're going to get rid of that nasty lump.
27:38You are.
27:38A unique, custom-designed implant created from Kato's CT scans
27:44will replace one side of his jaw.
27:48We've tried to tell him, but I don't know whether he's understood.
27:52But we've told you that it's a necessary thing, isn't it,
27:56that we have been done.
27:57Now, this is your present.
27:59This is as close to state-of-the-art as we can get.
28:03This 69 millimetres of metal
28:06is specifically designed to recapitulate bone.
28:10It's the first time this specific kind of reinforced
28:14honeycombed titanium implant has been used.
28:17So this goes on to the back of the jawbone there.
28:21And because this is three-dimensionally printed
28:24to fit this jaw exactly,
28:27when that slot's in there, it isn't going to wobble.
28:29Please, God, everything will go fine.
28:30You know what the risks are.
28:31Primarily infection.
28:33The secondary risk is mechanical,
28:35but I think we've done all we can
28:36to avoid a mechanical problem.
28:38OK, big guy?
28:40Good.
28:41You're going to be bionic?
28:42Yeah.
28:43I think you're going to be bionic.
28:45Kato.
28:48Roisin, this is Kato.
28:50Lovely, lovely Kato.
28:52Kato.
28:52You're going to be beardless.
28:55Noel and soft tissue specialist Jonathan
28:58will be performing the complicated surgery together.
29:01The main thing for me is that you can get the tumour
29:04out to your satisfaction.
29:05Yep.
29:05I'm confident we can get the implant done.
29:08OK.
29:09Jonathan begins carefully prizing the tumour away
29:12from the healthy side of the jaw.
29:15The big question is, are we going to be able to get all the tumour out
29:19without actually damaging the opposite side?
29:23Because it's got a lot bigger since the last time we saw it.
29:26So we're just going to put some local anaesthetic around the main nerve that feeds that lower jaw.
29:32So it's very similar to having a nerve block at your dentist.
29:35If this is what your dentist normally does to you, I'd go to a different dentist.
29:39So what John has done here is he's separated the tumour from the other jawbone,
29:47and I'm going to cut right between these teeth here, which are called the incisors.
29:52Noel will remove the entire left-hand section of jawbone that contains the tumour.
29:57The anatomically contoured 3D implant can then be fixed into place using special locking screws
30:05packed on either end with bone graft and sprayed with stem cells
30:10to encourage bone to grow into the titanium mesh of this new half-jawbone.
30:16So that's the jawbone with the tumour growing in it.
30:20So hopefully we've got all the tumour out.
30:22There's a little muscle and tissue on the side there,
30:25which hopefully will act as a buffer between the other bone so the tumour has not spread.
30:31With one side of the jawbone removed, the implant can now be put in place.
30:36It's a sculpture of rare beauty.
30:39Bone marrow extracted from near Cato's shoulder is then packed around the ends of the implant.
30:46Finally, Noel sprays on stem cells from Cato's bone marrow
30:51mixed with platelets and clotting factors from blood
30:54and a man-made catalyst glue that will help the mixture to set.
30:59So this is the future, a three-dimensionally printed implant that exactly fits the body,
31:03plus the body's own natural healing system propagates it
31:08to get the perfect marriage of mechanics and biology.
31:11That's our goal.
31:13Thanks very much, everybody. Well done.
31:16The cutting-edge surgery has taken two and a half hours.
31:21The 3D CT looks really good.
31:25You can see how the implant contours onto the mandible.
31:30It's very nice.
31:31Well, so far, so good.
31:33Now we've got to hope that the cells really help the tissue to grow on
31:36because I think mechanically that sound looks good.
31:47Super cat Simba is being transferred to Noel's Orthopaedic Centre
31:52to undergo the wolverine-inspired surgery on his fractured foot.
31:56But before the operation,
32:00Jonathan needs to uncover the skin graft he performed four days ago.
32:05The moment of truth, my friend, the moment of truth.
32:10Either the graft will come off on the bandage
32:12or the bandage will come off and the graft will stay on the leg.
32:17Pretty good all round?
32:23I would be happy with that.
32:25Yeah, that's all good.
32:27That's a huge relief.
32:29Well done, mate.
32:30Good.
32:31It's all up there.
32:32It's down to you now.
32:35My bit's done.
32:36My bit is done.
32:37No pressure.
32:38No pressure, then.
32:40All right, let's get the kit rocking and rolling.
32:42Well done.
32:43OK, thanks, Noel.
32:47Simba's metacarpal bones have fractured into tiny pieces
32:50very close to the joints.
32:54Noel needs to realign these bone segments
32:56so he can pin them into place.
32:58I'll try and find the bottom part here.
33:01Give me a 0.9mm drill bit.
33:05So as you can see, this is tiny.
33:08Noel inserts metal pins through the minuscule pieces of bone.
33:13Dealing with these bones is like trying to put matchsticks back together, really.
33:24Oh, my lord.
33:25Is this a pussycat or a hamster?
33:27And so Wolverine begins to emerge.
33:37So this isn't in any textbook.
33:39I don't think there's any other technique out there
33:41that will be superior to what we're doing now.
33:44But yet, it's not widespread in terms of acceptance.
33:48And I think that that's a real shame.
33:50OK, so we're just going to put a little bit of this bionic glue
33:56on each of the fracture sites.
33:58Hold that.
33:59Hold there.
34:01The team are pioneering another technique today,
34:04a newly developed gel with a bone protein suspended in it
34:08that should slowly help to heal the fracture.
34:10Oh, man.
34:12I love bionic juice.
34:19Finally, Noel builds a frame
34:21to take Simba's weight off the foot while it heals.
34:25So these are the pins that have gone up,
34:27like the Wolverine pegs,
34:29into the metacarpal bones.
34:31Meanwhile, we've held everything stable from the wrist down
34:35using this rod attached to this walking frame
34:38so that Simba can put this on the ground
34:40without affecting the foot.
34:43Having had two major operations in four days,
34:47it will be some time before Noel knows
34:50if Simba's legs will make a full recovery.
34:53I see you're missing your little friend as well, aren't you?
35:01Two days ago,
35:03two-year-old Staffy Tiny had the first operation
35:06to treat the painful erosion affecting his elbows.
35:10Come on, Noel.
35:13Stop being a superhero and bring us Tiny.
35:16Melissa and husband Saj have come to take him home.
35:20I've been desperate to get here.
35:21I've been pacing around for over an hour.
35:24And he was late home from work as well,
35:27so I was literally clock-watching.
35:30And, yeah, I was running to the car.
35:33Almost, really, wasn't I, to get here.
35:35I couldn't wait to get here to pick up my boy.
35:40Get myself prepared.
35:43Now, buddy, who's in here?
35:46Hello, darling.
35:47Who's in here? Go down to his level now.
35:50There we go.
35:51No excitement, mate.
35:52No excitement.
35:53You've got to be careful.
35:54Let me come in there with you.
35:56Happy to see you.
35:56Go down, Chef.
35:58Happy to see you.
35:59Let's go out into reception because he's quite boisterous.
36:02Now, as you can see, he's using it reasonably well.
36:05We'll go on the carpet there.
36:06Now, remember, although he feels full of beans,
36:09the reality is different.
36:11Yeah.
36:12The reality is he could break all those screws.
36:15Yeah.
36:15And believe you me, you don't want that.
36:17Oh, God, sorry.
36:17Yeah, do you want to get the car and just bring it up to the door?
36:20I think I'll get some sedatives for him for you to go home with,
36:24just in case.
36:28Do you know what?
36:28I've never known him to be like it at all.
36:30So these are sedative tablets not to be taking yourself,
36:40no matter how stressed you get.
36:41Okay?
36:42Damn it.
36:43I honestly think that once we get him home,
36:45he's just going to be totally zonked.
36:48Yeah, I'll tell you what.
36:49After what I've done to secure him at home,
36:51I'm either going to make a great dominatrix or a fab sailor.
36:55Oh, great.
36:55Okay.
36:56I'm going with sailing.
36:57But I'm going to leave Saj with the other aspect of that.
37:02Good lad.
37:03I'll take that.
37:04Yeah.
37:05Thank you so much.
37:06Mate, look out for yourself and keep that tongue in.
37:15Simba, the therapy cat,
37:17has been at Fitzpatrick's for four weeks now.
37:20Like many regular visitors,
37:22the staff can't help but become attached.
37:24It's the patients you see back week in, week out
37:27that you get to know really well.
37:29Hey, baby.
37:30They kind of become a little bit part of the family.
37:33Come on, sausage.
37:35You need to get wakey up.
37:36You've nursed this animal back to health.
37:40You kind of develop, like, this love for them.
37:44I honestly could fall asleep so easy right now.
37:49I have no favourites.
37:52No favourites?
37:52Some favourites.
37:53I have favourites.
37:54You can't help it.
37:56I do have favourites.
38:00But that's not a lie.
38:03Do you have favourites?
38:04Favourite animals?
38:05I like pandas.
38:07I mean, in the sets.
38:13Hey, do I get a hug?
38:16Ah, yeah, buddy, yeah.
38:18Well done, mate.
38:19For Kian, being away from Simba is proving challenging,
38:23so he and mum, Becky, have come for a visit.
38:25All righty.
38:26Do you want to see where he stays?
38:28Now, I don't normally do this.
38:30In fact, I'm not going to bring mummy through
38:31because normally I don't.
38:33So you have to stay by my side.
38:34Come on.
38:34Here we go.
38:37Come this way.
38:45Simba, look who's here.
38:47Hey, mate.
38:49Look who's here, buddy.
38:51There you go now.
38:53Shall we lift him out a little bit?
38:55There we go.
38:59There we go.
39:00Hello, beauty.
39:01Now.
39:02Steady, steady, steady, steady.
39:04As you can see, he's very lively.
39:06He wants to walk on it.
39:08Good boy.
39:09So why don't you chill out with him for a little while,
39:11just hang, and I'll come back and see you.
39:13All right, buddy?
39:13What would you say to no?
39:14You OK?
39:15You're very welcome.
39:16How do you feel to be with him?
39:20How do you feel to be with him?
39:22Happy.
39:22Happy.
39:23Oh, that's what you wanted to lay down.
39:25There's a good boy.
39:27There.
39:28Although Simba is gradually improving,
39:30he's not yet ready to go home.
39:38All right.
39:39It's five days since Kato received his bionic jaw implant.
40:05It may not be roast beef on the menu,
40:10but he certainly doesn't seem to have lost his appetite.
40:13We brought him all soft food in.
40:15We've not got any hard food.
40:16All soft treats for him as well to try and make it as easy as possible.
40:20He does have a really clever way
40:21that we've been able to inhale a piece of ham
40:24without actually chewing it.
40:26If you hold up a piece of ham, he just goes,
40:28and it's just gone.
40:29So I think he'll be OK.
40:31I can't imagine what it's looked like without his beard.
40:40All righty.
40:41Kato's mummy and daddy, how are you?
40:43Nice to see you smile.
40:45Nice to see you smile.
40:46Come on in.
40:47Oh, you've got a white box.
40:48That's super kind.
40:49Wow.
40:50Look at that.
40:51Look at that.
40:51Oh, look at that.
40:53Oh, that's amazing.
40:55Did somebody make that from his picture?
40:58It was a photo topper.
41:00That's brilliant.
41:00And then I've iced it.
41:02You iced it?
41:03Yeah.
41:03Hidden talent.
41:05Did she make one of those for your birthday ever?
41:08That's pretty impressive.
41:09Thank you so much.
41:10That's super kind.
41:11And I will go and get him for you.
41:12Thanks.
41:16You're not going to cry, are you?
41:17No.
41:20Now, who's in here?
41:22Oh, hello.
41:23Hello, family.
41:24Hello.
41:25Hello, family.
41:26Hello.
41:26How are you doing?
41:28Good.
41:28So, as you can see, he looks fit.
41:30I mean, you wouldn't know, really.
41:32Apart from he's lost his beard.
41:34Apart from he's lost his beard.
41:35I had to shave his beard off.
41:36But that'll grow back, won't it, Kato?
41:39It was great to see him.
41:40And I think it was great for him to see us as well.
41:44He seemed excited.
41:45Can I have a kiss-kiss?
41:46Are you going to forgive us for what we've done to you?
41:50There's a few little worries that we have.
41:52Whether the skin heals back to the implant
41:56and whether he gets an infection,
41:57but we're keeping our fingers crossed
41:59and hopefully it will all go well.
42:02We're going home now.
42:03We are.
42:07Come on, then.
42:08Come on.
42:22Come on.
42:23Come on, then.
42:24Well, no, he's just brilliant, isn't he?
42:52He's got my dog who I adore out of pain
42:56and you can't get better than that.
42:59Come on.
43:10All right, Simba.
43:12It's time to go home.
43:13Hey.
43:14Hey.
43:14Therapy cat Simba has spent two months at Fitzpatrick's
43:18after the car accident that devastated his front legs.
43:22Here he is.
43:25Hello.
43:26Hey, Simba.
43:27Look who it is.
43:29It's finally time to go home
43:31to continue his recovery with best friend Kian and the family.
43:34I don't think any of us ever, ever, ever, ever dreamed
43:38he could survive this.
43:41And here he is, happy and smiling and purring and...
43:44Oh.
43:46Coming home, darling.
43:47Oh.
43:52Simba will need to return for a check-up
43:54to see if his paw,
43:55held together with Noel's wolverine pins,
43:58has fully healed.
43:59It's five months since Kato
44:08had the tumour removed from his jaw.
44:11What's that?
44:11What have you got to do?
44:12Good boy.
44:13Do you like it?
44:14You don't like ham, do you?
44:15I'm going to have some ham.
44:16The insatiable lurcher's new bionic implant
44:19is making fast work of anything that comes his way.
44:23He is a bit more messy now.
44:26He tends to drop it all over the kitchen
44:28and bits fall out of the side
44:30where he hasn't got any teeth.
44:32Oh, you've got it all down the side of your mouth.
44:36And when he shakes, his tongue comes out
44:38and sometimes showers us a little bit.
44:40But we don't mind that, do we, eh?
44:42We don't mind a little bit of dog spit.
44:45That's very cute.
44:46For a while, I think we sort of thought,
44:48what have we done?
44:49And should we have, you know, should we have done it?
44:52I think him coping with it helped us cope with it, really.
44:55Kato, what about football?
44:57I don't even think now he's aware
44:59that anything's different.
45:00He's just a completely happy, bonkers dog.
45:05Yeah, we're at the forefront of veterinary medicine,
45:08but at the end of the day, we've got our dog
45:11and he's going to live for as long as he should live,
45:13so that's what really matters.
45:15The good boy.
45:16It's been seven months since Simba the supercat was hit by a car.
45:26Simba, come on.
45:28Simba's doing really well now.
45:29He's running around.
45:30He's taking Kian to bed as he used to.
45:32His hair's all grown back.
45:34There's no scars anywhere.
45:37Simba!
45:38And it's so nice to see Kian and Simba back together
45:43because the difference Simba makes in Kian's life is huge.
45:48You can get to pick him.
45:49It was very difficult without him.
45:52It just didn't feel safe.
45:58It's probably the best feeling ever, having him home.
46:02Other cats would have given up,
46:05but Simba just has patience and the will to live,
46:09and I never lost faith in him.
46:14He's my bestest friend.
46:15No-one could replace him as a best friend.
46:17He's the best cat in the world.
46:19He's the best cat in the world.
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