- 7 weeks ago
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00:00:00Dying from this procedure
00:00:04We can go from under control to emergency in a flat half an eyelash
00:00:10Beef means don't do that again
00:00:18It is very personal for me if you put a hole in here you'd be at risk of dying on table
00:00:25This is either life or death
00:00:30Oh
00:00:32Oh
00:00:34There you go
00:00:39I lost both my legs above the knee. I get pain which is like electric shocks
00:00:43Which they're the ones that kill me
00:00:47His kind of function is such that you wouldn't start out like this the risks would probably too high
00:00:54I mean he's at risk of dying from this procedure
00:00:57It's open a little bit for me
00:01:01So I'm going to have to relearn how to eat again and there'll be problems with my speech
00:01:06I'm just going to stab through the lip all the way
00:01:09So that's in effect and the jaw will hopefully break
00:01:18The biggest risk for dueling is an artery in the neck will burst
00:01:22The last thing you want to do is to make a hole in the jugular vein
00:01:25You've got the emergency list there?
00:01:26Do that one
00:01:27Don't worry it doesn't go anywhere
00:01:28Today we're going to operate on Luke
00:01:29And so he's he's a chap was injured in Afghanistan 15 years ago massive blast injury he came through it but he's got very high amputations
00:01:32He's going fast
00:01:33Increased control
00:01:37today we're going to operate on Luke and so he's he's a chap was in injured in
00:01:45Afghanistan 15 years ago massive blast injury he came through it but he's got
00:01:50very high amputations so first came in to contact with Luke immediately when he
00:02:01returned actually with a number of his colleagues who'd been injured around
00:02:04that time he's had some nerve pain which has been intractable operated on him in
00:02:102018 and then we which got some relief and today we're hoping to really attack
00:02:18both the right and the left side
00:02:21everybody's in the burden of injury that these chaps had it was phenomenal
00:02:28the nurse will do it wouldn't she oh there you go oh gosh gosh there you go
00:02:35and and often this level of injury was unsurvival he's had nerve pain his pain
00:02:44has really made him suicidal at times he doesn't feel he has a quality of life
00:02:49good morning my name's Heather I'm one of the nurses here so we'll just get on with the admission and get you ready is that okay
00:02:55let me move out your way
00:02:56you've been getting lots of pain yeah
00:03:02bad
00:03:03I was only young as 18 when I signed up
00:03:10instantly knew that I was a boy in a man's world when I rocked up to a training
00:03:16but it was what I needed I think I needed a bit of discipline at that time of my life
00:03:22so I was uh 20 when we deployed to afghan it was in october 2011
00:03:28um I weren't there long I was only there six weeks before I got injured
00:03:33my section in afghanistan
00:03:36if you leave me there and there's the other lad that got injured
00:03:41there's me a young fresh uh fresh face buddy
00:03:50some good good good legs some big feet
00:03:53uh yeah I was quite tall I was six foot one
00:03:57it was just a normal day and normal foot patrol
00:04:05and we left our checkpoint quite early in the morning
00:04:09we patrolled up to where the rest of our team was staying
00:04:14trying to fight back where the Taliban had a quite really stronghold
00:04:18but as the lads started to search the compound and clear the compound
00:04:23three of us got placed on overwatch looking in giving cover
00:04:27and I just literally I got up and walked around and that's when I stood on the IED
00:04:32last meet there and the IED was around this area here
00:04:40unfortunately the bloke who searched it missed it
00:04:42but I think anyone will miss it it's me and you can't tell where it is
00:04:45but I've got up and walked around and stood on it and detonated there
00:04:49I lost both my legs above the knee straight away
00:04:54I had damage to my left arm and to my left hand as well
00:04:58I broke my pelvis in three places
00:05:02and then I suffered a cardiac arrest for nine minutes
00:05:06it's weird talking about it in this much depth as well
00:05:14but I haven't really spoke about it in depth like this before
00:05:17I think if it was anywhere else in the world I would have probably died
00:05:24but I think it's the fact that it was in Camp Bastion
00:05:27that we had the best trauma doctors ever
00:05:29there's not many people with my injury that survived
00:05:34I just love normal life
00:05:45I mean it's never going to be normal we've been amputee and that
00:05:48but I love to be about to plan stuff and stick to it
00:05:52and enjoy my life again
00:05:55like it's been since November last year
00:05:58it's been the most challenging part of my life
00:06:01because the pain has been pretty much constant from then
00:06:04I've asked one of our peripheral nerve surgeons Sam George to help me with Luke's operation today
00:06:13so Luke was injured in I think it was 2011
00:06:19he looked at some of his original injuries from Camp Bastion
00:06:23it was quite dramatic
00:06:26lots of the IED blast was pushed up into the pelvis and created a very difficult traumatic injury to treat
00:06:37so here we can see the right side of the pelvis with the nerves coming down
00:06:43the pain is being driven by what we call a neuroma
00:06:46so whenever a nerve end is cut the nerve cells they tend to form a chaotic ball of swelling of the nerve
00:06:56which then produces a lot of pain
00:06:58whenever you tap or knock a neuroma or you're obviously sitting on it or it's on your prosthesis
00:07:04that can just keep driving pain from it
00:07:07what we do is we take this nerve end after we've cut the neuroma out
00:07:11and target it and direct it to another muscle nerve
00:07:15going to a muscle that the person doesn't need
00:07:18the nerve grows into the muscle to give it something to do
00:07:22so it stops giving Luke pain
00:07:24the risks for this surgery are fairly broad
00:07:29and it's one might say fairly simple surgery techniques
00:07:34in a way that we're just going to connect up some small nerves together
00:07:39or put small amounts of muscle around the nerve endings
00:07:42but the challenges for us are that we're actually quite close to his bowel
00:07:48we're quite close inside the pelvis
00:07:50got that blood pressure
00:07:52thank you
00:07:53and I think the other thing is that unfortunately
00:07:55as with quite a few of these guys
00:07:57he's got cardiovascular ageing of his system
00:08:00and he's got a very large heart that isn't beating as well as it might in someone of his age
00:08:06it might not get rid of all his pain
00:08:20it might not get rid of even a portion of his pain
00:08:23there's always a possibility that there's no change
00:08:26arthritis
00:08:26so Luke's pain has been very intractable at times
00:08:32I think it's really affected his dynamic at home
00:08:36he's certainly been very close to suicide at times
00:08:40has often come to me to see me in clinic
00:08:43often talking about suicide
00:08:44that he can't go on
00:08:46that he needs something done
00:08:48because otherwise his life's not worth living at the moment
00:08:50because his pain is so intractable
00:08:51and even his daughter has sat with me in the clinic in tears
00:08:56it's quite hard for us to cope with in a way
00:09:01because at times it's felt like there's not many options for us
00:09:05I get two different types of pain
00:09:12I get one background pain
00:09:14which is sort of
00:09:16if you imagine the static on a TV
00:09:19if you imagine that as a feeling
00:09:20that's what I seem to get 90% of my life
00:09:22and then I get another pain
00:09:24which is like electric shocks
00:09:25which they're the ones that kill me
00:09:28it stops my life basically
00:09:31I haven't got a life at the minute
00:09:32it's what we live day to day really
00:09:36so yeah it's crippling
00:09:39simple things that most people take for granted
00:09:47is something that we don't have at the moment
00:09:50so this surgery hopefully is going to be
00:09:53the one that works
00:09:55and we can
00:09:55we can just enjoy
00:09:59being married and being a family
00:10:02if this don't ease today
00:10:05I can't see the next phase of my life being bright to be honest
00:10:09it's hard to hear him talk
00:10:14if this doesn't work then
00:10:16I don't know how we'd move forward
00:10:19so
00:10:21hi Luke you alright
00:10:34so obviously we're going to address the two nerves
00:10:38that are causing problems on either side
00:10:39what we're trying to do is
00:10:41we wrap a small piece of muscle
00:10:43around the end of the nerve
00:10:45and they really do seem to affect pain
00:10:48particularly
00:10:48that's been caused by neuromas like this
00:10:51it's a little bit controversial
00:10:53because with someone that's had this pain for such a long time
00:10:57I think there's a belief that maybe this isn't going to work
00:11:01so
00:11:03what could
00:11:06you know
00:11:07the potential that
00:11:08one of the nerves is really close to the bowel
00:11:13so it's a
00:11:14chance that we could damage the bowel
00:11:16that's our concerns
00:11:20I suppose
00:11:20and I think
00:11:21for us sharing
00:11:23you know
00:11:24as partners in this
00:11:25you know
00:11:26something that we've spoken about quite a lot
00:11:28and you know
00:11:28you have to understand that
00:11:30because nothing is without risk
00:11:32okie dokie
00:11:36rock and roll
00:11:39get the show on the road there
00:11:40yeah
00:11:40brilliant
00:11:41ok
00:11:42great
00:11:42is there anything else you want to talk to us about
00:11:44there's always more pressure
00:11:49when you're treating someone that you know
00:11:50quite well for such a long time
00:11:52and also there's this bond between us
00:11:54that
00:11:55that you don't get
00:11:57elsewhere
00:11:58I've been trained
00:12:00within the army
00:12:02both in the UK
00:12:03and overseas
00:12:04culminating in my time at Camp Bastion
00:12:07treating soldiers like Luke
00:12:09we all had this brother bond
00:12:14that we were looking after our team
00:12:16that were trying to do their thing
00:12:18I've been fighting his corner for
00:12:22you know
00:12:23for such a long time
00:12:24and that burden
00:12:25is not without some cost
00:12:27yeah
00:12:30it's um
00:12:31it's difficult isn't it
00:12:31you know
00:12:32these things weigh on your mind
00:12:33all the time
00:12:34sorry
00:12:41it's not without risk
00:12:48I've carried through
00:12:49the responsibility of trying
00:12:50to bring everybody together
00:12:51to persuade them
00:12:52that this chap
00:12:54really has just one last chance
00:12:55for us to operate on him
00:12:56to give him some level of normality
00:12:58that we all enjoy
00:13:00can I just shake him
00:13:14yeah
00:13:15okay
00:13:16so if K 0-4
00:13:180-2
00:13:18oh no
00:13:19I think as a family
00:13:26we hope for relief
00:13:27for Luke
00:13:29he's had such a rough ride
00:13:30the last few years really
00:13:32that my dream would be
00:13:34that this works
00:13:35and can give Luke
00:13:36relief
00:13:37of the pain
00:13:39that would be my dream
00:13:40give Luke a love then
00:13:42love you
00:13:46I love you
00:13:47see you later
00:13:48all right
00:13:49love you
00:13:50love you
00:13:50in my eyes
00:13:53he's got the heart of a lion
00:13:55and he copes with the pain
00:13:57very well
00:13:58even though
00:13:59it's excruciating
00:14:00I'm so proud of him
00:14:02it's been a long road
00:14:04to this day
00:14:05Luke's got every faith
00:14:07that Colonel Fossey
00:14:08has put his life
00:14:09in his hands
00:14:09really
00:14:10pray to God
00:14:11that he'll come through
00:14:12it all all right
00:14:13here he is
00:14:16oh you've finally
00:14:18turned up then
00:14:18I thought you'd gone
00:14:21for a fag or something
00:14:22we're going to do
00:14:36the right side first
00:14:37get us all sorted
00:14:38and then we're going
00:14:39to do the left side
00:14:39well
00:14:42he'll be fine
00:14:43over the last few years
00:14:45his pain's got worse
00:14:46and he's been
00:14:47very close to suicide
00:14:49a number of times
00:14:50now
00:14:50I think his family
00:14:51have found it
00:14:52extremely distressing
00:14:53I felt strongly
00:14:54that we should
00:14:55have another try
00:14:56at this surgery
00:14:57where he would say
00:14:58to me even if I can
00:14:59get one more year
00:15:00of relief
00:15:01that would be better
00:15:01than my life
00:15:02at the moment
00:15:03which is not worth living
00:15:05if I didn't have
00:15:12the surgery today
00:15:13I think I would end up
00:15:14dead anyway
00:15:15the pain has been
00:15:16pretty much constant
00:15:17so Luke's heart
00:15:26is already weak
00:15:27because of his
00:15:27traumatic injuries
00:15:28that he sustained
00:15:29in the bomb blast
00:15:30so we're going to
00:15:31need to monitor him
00:15:32very closely
00:15:33to see how he copes
00:15:34with the anaesthetic
00:15:34drugs
00:15:35what we may find
00:15:37is that his physiology
00:15:38is not coping
00:15:38and this will make
00:15:40the surgery more risky
00:15:41let me just get
00:15:45a little bit
00:15:45of information
00:15:46when we see
00:15:47what Damo's
00:15:48spoken to
00:15:48okay
00:15:55okay
00:15:56I've just spoken
00:15:57to the anaesthetist
00:15:58Luke's heart
00:15:59is not pumping
00:15:59very well
00:16:00has he reacted
00:16:03to something
00:16:03then do you think
00:16:03he's now at
00:16:05serious risk
00:16:06of cardiac arrest
00:16:07his cardiac function
00:16:11is such
00:16:12that you wouldn't
00:16:13start out like this
00:16:13the risks
00:16:14were probably too high
00:16:15but the risks
00:16:16are already up now
00:16:17do we carry on
00:16:18we can then do
00:16:20the operation
00:16:20we promised Luke
00:16:21or are the risks
00:16:23of surgery now
00:16:23too great
00:16:24it was tough
00:16:26so today we're
00:16:45going to be operating
00:16:46on Julian
00:16:47who's got a
00:16:47tongue cancer
00:16:48going to be removing
00:16:50part of his tongue
00:16:51and reconstructing
00:16:52it with skin
00:16:53from his arm
00:16:54but because of
00:16:55the nature
00:16:56of the cancer
00:16:56and where it is
00:16:57we are going to
00:16:58have to split his jaw
00:16:59with what we call
00:17:00a mandibulotomy
00:17:01to gain access
00:17:02to the jaw
00:17:03morning
00:17:04Julian's cancer
00:17:07has been acting
00:17:08quite aggressively
00:17:09so therefore
00:17:10this is quite
00:17:11a radical operation
00:17:12if you leave
00:17:14these cancers
00:17:15they are ultimately
00:17:16life-threatening
00:17:17and you can
00:17:18die as a consequence
00:17:20so Julian's
00:17:30in this position
00:17:31where he's got
00:17:31this tongue cancer
00:17:32and this tongue cancer
00:17:34is right at the back
00:17:36it's at the junction
00:17:37of the front part
00:17:38of the tongue
00:17:38and the back
00:17:39we need to gain
00:17:41access to that area
00:17:43such that we can
00:17:44remove that tumour
00:17:45cleanly
00:17:46while at the same time
00:17:48allowing us to get
00:17:49in there
00:17:49to reconstruct
00:17:50the tongue
00:17:50that will be
00:17:52very difficult
00:17:53as you can imagine
00:17:54by just going
00:17:55through someone's mouth
00:17:56so while
00:17:56people can open
00:17:58very wide
00:17:59it can prove
00:18:00very difficult
00:18:01to get to the back
00:18:02from a visual
00:18:04perspective
00:18:04splitting someone's
00:18:06lip
00:18:06and then
00:18:06splitting the jaw
00:18:08even for us
00:18:10as
00:18:10seasoned surgeons
00:18:12it is impressive
00:18:13so we will
00:18:15cut the jaw
00:18:16in front of
00:18:17this little hole
00:18:18here
00:18:18and then that
00:18:20will allow us
00:18:20to open the jaw
00:18:22so it's going to be
00:18:23opened up a bit
00:18:24like a book
00:18:25so the jaw
00:18:26is sitting there
00:18:26in a U shape
00:18:27and we will be able
00:18:28to swing this jaw
00:18:30out on the left
00:18:31hand side
00:18:32and it will pivot
00:18:34on the jaw joint
00:18:35here
00:18:35all the skin
00:18:38and the lip
00:18:38and the cheek
00:18:39comes out with it
00:18:39and then that will
00:18:41allow us to get
00:18:41a direct view
00:18:43into this area
00:18:44here
00:18:45so we do need
00:18:47to reconstruct this
00:18:48and we have to use
00:18:48this technique
00:18:49called microvascular
00:18:50surgery
00:18:50which is where
00:18:51we take skin
00:18:52from elsewhere
00:18:53in the body
00:18:53along with the blood
00:18:55supply that supplies
00:18:56that skin
00:18:57to reconstruct
00:18:58the defect
00:18:59and the blood vessels
00:19:00that supply that skin
00:19:02can then be plumbed
00:19:03into blood vessels
00:19:04that we've prepared
00:19:05in the neck
00:19:06but with all these
00:19:08operations
00:19:08there are going to be
00:19:09specific risks
00:19:10to what we're doing
00:19:11I think the biggest
00:19:17risk for Julian
00:19:18is infection
00:19:18or bleeding
00:19:19an artery
00:19:20in the neck
00:19:21will burst
00:19:21and consequently
00:19:23they'll either
00:19:24bleed externally
00:19:25or they'll bleed
00:19:26into the mouth
00:19:26he'll be getting
00:19:37long
00:19:37and it's tough
00:19:39so if we're doing
00:19:40again
00:19:41this is going to be
00:19:43Just to get your blood pressure done, a few details.
00:19:47Are you right or left-handed?
00:19:48Right-handed.
00:19:50It's going to be some radical surgery.
00:19:54It's going to be very weird having all this happen.
00:19:57I used to be a chef in the Navy.
00:19:59Food's always been such an important part of my life.
00:20:01I love food. I love anything to do with it.
00:20:05And so to lose what your tongue does,
00:20:08which we all take for granted every day,
00:20:10so I'm going to have to relearn how to eat again.
00:20:16And there'll be problems with my speech.
00:20:18So it's going to be a bit of a journey,
00:20:21and whatever happens afterwards,
00:20:23when I come to, I'll just deal with it.
00:20:30Right, chair's a contractor.
00:20:35Are you still taking that?
00:20:36I stood on the board.
00:20:38Oh, this way down.
00:20:42My name's Jamie.
00:20:43Nice to meet you.
00:20:44I think you'll try it this morning.
00:20:46Get yourself as comfortable as you can.
00:20:51It's all about getting back to my daughter.
00:20:52I love her very much.
00:20:55And this has been tough for everyone.
00:20:57This isn't just about me.
00:21:01The wider family and the impact it has on them,
00:21:03which is dramatic.
00:21:04Even though I'm the one with a cancer,
00:21:13it doesn't matter.
00:21:13Everyone else is going through it.
00:21:14I'll get my gloves on while you put the arm out, sir.
00:21:39If that's all right.
00:21:43The main risks is bleeding.
00:21:46We're operating in the neck,
00:21:47next to the carotid artery and jugular vein.
00:21:50And you can make holes in these vessels,
00:21:53and the bleeding can be significant.
00:21:55So, this is a complex operation.
00:22:00I'm going to be working on removing the cancer from Julian's tongue,
00:22:03while my colleague, Sat,
00:22:04will be raising the plaque from Julian's arm
00:22:06that will be used for reconstructing the tongue.
00:22:10We're going to take the skin from the arm with the blood supply,
00:22:14and with it will be two tiny veins.
00:22:16So, basically, we're taking that skin,
00:22:18and the nice thing is you've got a tattoo there.
00:22:21It'd be nice not to disturb it.
00:22:23So, we'll just make a straight-line incision
00:22:25so we can get it back together fairly accurately.
00:22:28Duration?
00:22:30Six hours.
00:22:32Antibiotics?
00:22:34Thank you very much.
00:22:36It's a massive operation for Julian,
00:22:43and you always get a little bit nervous
00:22:46because you're putting the patient through something massive.
00:22:50You always have that slight degree of anxiety,
00:22:54which I'd like to think helps you perform better.
00:22:58All right, ready to start.
00:23:01I'll have the lower premolar forceps.
00:23:05To access Julian's cancer,
00:23:06I need to get right to the back of his throat.
00:23:11We don't want to take out any more teeth than we have to.
00:23:14I'm going to give it a wobble.
00:23:16We're just going to give it a little dab.
00:23:23So, at the moment,
00:23:24we're just cutting through fat in the neck.
00:23:28What we find is that
00:23:29in this bit here
00:23:31between underneath the chin and the neck,
00:23:33if you do a straight line,
00:23:35as it heals,
00:23:36you end up with a tight scar band.
00:23:40And so, by throwing this little Z in,
00:23:41it tends to be a bit less obvious.
00:23:45I'm going to be really careful
00:23:47about the nerve which moves his lower lip.
00:23:52It's only a little nerve.
00:23:54So, if we separate those like that,
00:23:56that's lovely.
00:23:56So, the nerve which moves his lip
00:23:59is going to be down here somewhere.
00:24:01And the facial nerve is a nerve
00:24:02which supplies movement to the face.
00:24:06If I cut this nerve,
00:24:07Julian could have permanent damage
00:24:09to his speech and swallowing.
00:24:10So, I'm coming onto the gland
00:24:12and then forward.
00:24:15And this way,
00:24:15I'll be protecting the nerve.
00:24:21He's got a right plethora
00:24:23of veins here,
00:24:25which makes life
00:24:27a pain.
00:24:28There's a 25% chance
00:24:32that Julian has cancer
00:24:33in his lymph nodes.
00:24:34So, we're going to remove them.
00:24:37Unfortunately,
00:24:38I'm working down a big hole
00:24:39where at the base of that hole
00:24:41is the jugular vein.
00:24:45It's a big vein.
00:24:46It's usually about
00:24:46the diameter of your thumb.
00:24:48It's a big blood vessel
00:24:50that drains blood
00:24:52from the head and neck.
00:24:54So, I'm just being
00:24:58a bit careful at the moment
00:24:58because he's got loads
00:24:59of little veins.
00:25:01Clearly,
00:25:02the last thing you want to do
00:25:04is to make a hole
00:25:05in the jugular vein.
00:25:08If I damage that,
00:25:09it could lead to a serious bleed,
00:25:12which could be a risk
00:25:13to Julian's life.
00:25:24I need to go and speak
00:25:26to the patient.
00:25:29Hopefully,
00:25:29those are the haemophilters,
00:25:31rather.
00:25:31Go down there.
00:25:32Matt,
00:25:33go down.
00:25:37Is the sun going
00:25:38on his ears, John?
00:25:40It should be.
00:25:42It was,
00:25:43it's not enough.
00:25:45We just...
00:25:46We need to make a decision,
00:25:48but we need to make
00:25:48a decision quickly.
00:25:50Yeah.
00:25:52Okay.
00:25:52So, timelines,
00:25:54do you think 11 at the moment?
00:25:57Yeah.
00:25:57I'll just start to...
00:25:58Sure.
00:25:58Okay.
00:25:59If we don't try now,
00:26:02I don't think he'll do
00:26:03very well afterwards
00:26:04because he can't carry on
00:26:06with the pain like he is,
00:26:09and he's been so close
00:26:10to suicidal a few times
00:26:11that he would want us
00:26:13to carry the risk with him.
00:26:17Luke is now at significant risk
00:26:19of fatal cardiac arrest.
00:26:21We need to have a chat
00:26:22with the medical director
00:26:22to see if we should proceed.
00:26:26Hi, Peter.
00:26:26Sorry.
00:26:27I just wanted to sort of
00:26:28let you know
00:26:28that this was going on.
00:26:30He's been anathetized,
00:26:32but we've now...
00:26:34He just wasn't responding
00:26:35very well.
00:26:35There's a risk of death
00:26:37that there wasn't before,
00:26:38and, you know,
00:26:39I know Luke really well.
00:26:40You see,
00:26:41he's been with me
00:26:42for 10 years,
00:26:43more than 10 years now.
00:26:44So we've kind of gone through
00:26:46in our minds really
00:26:48that, you know,
00:26:49Luke would want us
00:26:50to carry on
00:26:50and just wanted to make sure
00:26:52that you were aware
00:26:54rather than anything else,
00:26:54rather than, you know,
00:26:56so that you know
00:26:58what it's like
00:26:58with these decisions.
00:26:59It's always a bit tough.
00:27:00If you know what I mean,
00:27:03it's one of these things
00:27:04that, you know...
00:27:07No.
00:27:11Yeah.
00:27:12Great.
00:27:13No, no.
00:27:13Okay.
00:27:14Yeah, sure.
00:27:16Okay, thanks.
00:27:16Thanks, Pete.
00:27:17Okay, cheers.
00:27:18Yeah, okay.
00:27:18Bye.
00:27:18Bye.
00:27:19Okay, cheers.
00:27:20Bye.
00:27:27Okay, all right.
00:27:28Let me phone her then
00:27:29and let's just...
00:27:30I'll put one speaker.
00:27:31Yeah, yeah.
00:27:32I need to have a call
00:27:33with Luke's wife, Abby.
00:27:34I need to make her aware
00:27:35that the risk of Luke
00:27:36dying on the table
00:27:37is much more significant.
00:27:38Hi.
00:27:39Hi, Abby.
00:27:40Hi, yeah.
00:27:40Yeah, so you've got
00:27:42myself and Damien
00:27:44in the room.
00:27:44We're just going to
00:27:45sort of talk to you.
00:27:47Effectively,
00:27:47we've not started
00:27:48his operation yet,
00:27:49but we've come on
00:27:50to a few hurdles,
00:27:52mainly around
00:27:52his cardiac functions.
00:27:54His ejection fraction
00:27:55is probably, you know,
00:27:56if I'm being very optimistic,
00:27:5820%,
00:27:58but running
00:27:59between 10% and 20%,
00:28:01and we've got
00:28:02a lot of monitoring
00:28:02down to work that out.
00:28:05So,
00:28:06in an ideal situation,
00:28:08we'd cancel him now
00:28:10and we'd send him
00:28:12to the cardiologist
00:28:13to work out
00:28:17what to do
00:28:18and how we could
00:28:19optimize him.
00:28:20But I think
00:28:21we all feel
00:28:22that the chances
00:28:23of us getting him
00:28:24back here
00:28:25in his state
00:28:25right now
00:28:26of next to nil.
00:28:28So,
00:28:29this is where we are.
00:28:31He's,
00:28:32I suppose,
00:28:35the way to say it,
00:28:35I mean,
00:28:36he's at risk
00:28:36of dying
00:28:37from this procedure
00:28:38more than we thought.
00:28:39what's the chance
00:28:46of Luke's survival now?
00:28:47I don't know.
00:28:49It's true.
00:28:50We've never seen
00:28:51this kind of case before.
00:28:52I can't actually
00:28:53give you a number.
00:28:55What I can tell you
00:28:55is it's not as good
00:28:56as it was before.
00:28:57it's impossible
00:28:59for us to put
00:29:00any figures
00:29:00on things.
00:29:01That's not what
00:29:02we're after now.
00:29:03We just,
00:29:03you know,
00:29:03what we need
00:29:04to impart to you
00:29:05is that,
00:29:05you know,
00:29:06if this is what
00:29:06Luke would want.
00:29:09Yeah,
00:29:10I think Luke
00:29:12wants surgery.
00:29:13He wants to try
00:29:14and get a normal
00:29:15on back.
00:29:15We don't have
00:29:16a lot.
00:29:17Luke doesn't have
00:29:17any form of life
00:29:18at the moment anyway.
00:29:20And I think
00:29:21that's important
00:29:22for us to understand
00:29:22so that we can
00:29:23share this with the team
00:29:24so that the team
00:29:25will feel
00:29:25it's the right thing
00:29:27to do.
00:29:28Yeah.
00:29:28So Luke,
00:29:29you want to use
00:29:30if surgery
00:29:32doesn't kill you,
00:29:33the pain
00:29:33and the patient
00:29:34and will kill yourself
00:29:36if he carries on
00:29:38on this.
00:29:40Go ahead.
00:29:40I think that's
00:29:41the understanding.
00:29:41It was kind of
00:29:42our decision to make
00:29:43and I think
00:29:43me and Mark
00:29:45have decided
00:29:46I think that's
00:29:46the way to go
00:29:47given all the things
00:29:49we've said to you.
00:29:51Yeah.
00:29:52Alright?
00:29:53Yeah.
00:29:54I'll,
00:29:54you could
00:29:56drop me
00:29:56to give Gary a call.
00:29:57I'll give his dad a call
00:29:58then.
00:29:58Yeah.
00:29:59Okay.
00:29:59And just try
00:30:00to keep yourself busy.
00:30:01I'll give you a call
00:30:02afterwards.
00:30:03Alright?
00:30:04Okay.
00:30:04Thank you so much.
00:30:06Bye.
00:30:06Bye.
00:30:07Bye.
00:30:07See you around.
00:30:08See you around.
00:30:09Bye.
00:30:09Bye.
00:30:09Bye.
00:30:10Bye.
00:30:10Bye.
00:30:10Bye.
00:30:11Bye.
00:30:11Bye.
00:30:11Bye.
00:30:16Are you going
00:30:17somewhere else?
00:30:18No,
00:30:18I'm just hanging
00:30:18around for a couple
00:30:19of minutes.
00:30:19I'm going to
00:30:20get you on.
00:30:21Bye.
00:30:22Bye.
00:30:22Bye.
00:30:22Bye.
00:30:22Bye.
00:30:22Bye.
00:30:23Bye.
00:30:23Bye.
00:30:23Bye.
00:30:25Bye.
00:30:26We have made
00:30:27a decision that with knowing him
00:30:31and having a conversation with his wife that although he's under significant risk
00:30:37now, I'm sure he would be telling us to carry on and to, you know, I certainly don't
00:30:44want to put him through anything that is unnecessary, but of course now we feel that this is life sailing.
00:30:50And that was an amazing thing that I was escaped.
00:30:52And it seems so like – because you heard theную thing looking for us, I don't really
00:31:03have connection with anyone.
00:31:04They were coming with him to isso.
00:31:05OK.
00:31:06grab the consent form for me. And so planned procedure is that we're going to do this bilateral
00:31:12sciatic nerve explorations just to bring the team into the discussion. I think beforehand
00:31:23we didn't think there was a significant risk of death as part of the procedure. I think
00:31:28we now think there is a significant risk. I've discussed this with his wife. I've also
00:31:34spoken to the medical director as well who is supporting our proceeding based on the
00:31:39fact that this is probably the only time we're going to get Luke here in this position. And
00:31:44he's already at significant risk but we feel that is worth it. It's what he would want and
00:31:48that's what we've gone down. Is there anybody that really feels strongly about proceeding?
00:31:54Great. I think it's important that we all feel together on this.
00:32:04There's definitely a pressure. I do feel that making decisions for him have to be very
00:32:10circumspect which is completely why I've involved many other members of the team trying not to
00:32:15allow any relationship that might have developed between us as friends to cloud what we are
00:32:22trying to do to help him. Well I think he's placing all of the success on this.
00:32:28He's at the point where he's willing to try anything. Yeah. Let's hope we can find the bloody nerves quickly.
00:32:34As in when we make the first incision. Okay. How are we doing then? Are we ready
00:32:40to... The bomb blast damage to Luke's thigh makes locating the nerves particularly challenging and we
00:32:46only have a limited amount of time under anaesthetic. The neuroma's somewhere there.
00:32:50Okay. We go a bit like that. We are going in at the top of Luke's thigh on the right side of his
00:32:56remaining pelvis. Great. A knife please. I'm gonna make it this big I think. We don't
00:33:04want him under anaesthesia for too long. Time pressure acutely to the surgery now is
00:33:08more because of the anaesthetic risk and the longer he's under surgery the longer his
00:33:12body is experiencing trauma. The right leg is going to be... is easier. This is the
00:33:22right that we're doing now. This is slightly easier as opposed to its virgin territory.
00:33:26The bigger the better. Yeah. Prior to this the risks were from the operation itself. Risks
00:33:34of his... to his bowel, risk of bleeding and things like that. Now it risks his actual whole
00:33:39body because of his heart.
00:33:49I made the incision. We've just gone through the skin and we're just into the subcutaneous
00:33:53fat now. So we're now going to raise tissue to allow us to... to see the nerve. I think
00:33:58we've got... We might be close to the nerve. We're just trying to orientate ourselves a
00:34:03little bit. So you can feel... you can feel the bone there. Is that nerve or the scar?
00:34:10We need to find the nerve that has the neuroma on the end of it which is causing Luke's pain.
00:34:15That's right. How is it there? Yeah. So we're just... I'm just exposing the nerve now. I think
00:34:22you can see it. That's the neuroma. Yeah. You can feel it. Yeah. The body of the nerve is in the
00:34:28spinal cord. Or in your brain. You know, the cell body. So the nerve doesn't die when
00:34:33the nerve gets cut. It's like a starfish trying to regrow its... its... its legs. So the...
00:34:40when you cut the nerve, the ends... the nerve cells are still alive at the end of the nerve
00:34:45and they try to regrow. But there's nothing to regrow to. So they... they grow in a chaotic
00:34:50fashion and they... and that causes a lot of pain. Sam is going to give the nerve that is causing
00:34:56the pain something to do by stitching the freshly cut end into some muscle. The hope
00:35:01is that it will grow into the muscle and stop giving him pain. And particularly these muscles
00:35:07that we're choosing aren't really doing very much now. And so if we can give them something
00:35:11to do it will really help. Yeah. We'll remove the neuroma. We'll cut it back to where the nerve's
00:35:18healthy. Take a nice good chunk there. Make sure we're a couple of centimeters from the neuroma. And then just make a nice
00:35:24clean sawing cut there. And you can see how healthy the nerve fascicles are there.
00:35:31Yeah, you can see this... this lump that's formed... where these fascicles at this end have tried to form new connections and not been able to.
00:35:45And then that is very exquisitely sensitive. So as soon as you bash on that a tiny little bit it will send
00:35:54big electrical signals down the nerve and cause him intense, excruciating pain.
00:36:00This is quite big so I'm going to just wrap it with muscle. It's kind of a belt and braces type thing.
00:36:05So microscope, is it ready?
00:36:07Can I turn this to 62?
00:36:10The anaesthesis is especially important in this operation.
00:36:14They're keeping a close eye on how Luke's heart is coping at every stage.
00:36:19Yep.
00:36:26So we're just doing microsurgery just to join up that branch we found to the main sciatic nerve.
00:36:34We really want to make sure that the cut nerve iron securely with the muscle to form a healthy connection that will grow.
00:36:41Otherwise there is a risk that Luke's pain comes back.
00:36:44So it's tiny stitches, that's why we need the microscope.
00:36:48And we're going to orientate it to the correct sort of fascicles as well.
00:36:55We're going for a third one here.
00:36:57Yeah, actually I like that idea, yeah.
00:37:00Just to orientate it a little bit.
00:37:04Looks great Sam.
00:37:06Yeah, brilliant mate, brilliant, really good.
00:37:12Okay.
00:37:14Yeah, we're done.
00:37:15We're just going to close up.
00:37:16Back on, back on please.
00:37:18Great.
00:37:21So part one done.
00:37:22We've done the right side.
00:37:24Yes, we managed to excise the neuroma.
00:37:26And now on to the left side.
00:37:28The bigger challenge, yeah.
00:37:32We've successfully completed half the operation.
00:37:34But now we're moving on to the more difficult left side, where there are more risks.
00:37:41It's very close to the peritoneum, very close to the bowel.
00:37:43So it would mean us inadvertently tearing a bit of scar tissue that's attached to the bowel
00:37:48that would then open up the bowel, which obviously is full of bugs.
00:37:54This could cause a life-threatening infection like sepsis.
00:37:59So we've been, what have we been, two in a, we've been two hours haven't we really?
00:38:05The longer he's under surgery, it's a load on his heart which is already compromised.
00:38:09I'm worried that Luke's heart could stop at any moment, just as we're about to go into the most risky part of the operation.
00:38:19Is he okay?
00:38:24If he did end up going into cardiac arrest, we'd have to obviously stop what we're doing.
00:38:29Get the drapes off, turn him onto his back as quickly as possible and start cardiac compressions.
00:38:39Okay, he's got to go into the last hand.
00:38:46Yep.
00:38:47Er, Eh, Park, we've got to...
00:38:49Alright, thanks, H.
00:38:56Medium swap, please.
00:39:09We're trying to get low in the neck, and access is always tight and difficult.
00:39:16Julian has a survival advantage by us removing the lymph nodes in his neck that may have cancer in them.
00:39:22So I'm just going to come onto the jug from above.
00:39:27We're avoiding all the named blood vessels,
00:39:30but there are plenty of little blood vessels that don't have a name,
00:39:34which are big enough to spoil your day in a way.
00:39:37So now I can finally get access to his lymph nodes and remove them as a whole.
00:39:52In the neck is all the fat and the glands that have got cancerous cells in there.
00:39:58We've removed all the lymph nodes in the neck,
00:40:02and in doing so, we've come down to the jugular vein,
00:40:06so we've separated the jugular vein, and we've taken all the tissue out from around it.
00:40:13The first stage of the operation is over,
00:40:16so now I need to split Julian's jaw to get to the cancer in his tongue.
00:40:20Fifteen places.
00:40:22And we're going to split the lip and do a mandibulotomy.
00:40:25I'm just going to stab through the lip all the way and then carve through the lip.
00:40:36Lovely.
00:40:37So squeezing the lip and pulling it up and out.
00:40:42And so I'm going to cut through that muscle in a minute and then come above it.
00:40:47I'm just going to go straight through the blade, back to you.
00:40:50So we're going to go straight down.
00:40:56Straight down the middle.
00:40:57And when we do our bone cuts, we need to do our bone cuts such that we don't injure the teeth
00:41:09and we don't injure the nerve.
00:41:11Saw into me, please.
00:41:13So we're just completing the bone cuts now.
00:41:31So that in a second the jaw will hopefully break.
00:41:37And a mallet, please.
00:41:43So we're just doing some little tap-taps.
00:41:46And you can just see the beginning.
00:41:48It's beginning to open up.
00:41:51Now you've got good movement.
00:41:52So you've got to be careful that we don't tear this too much
00:41:56because obviously here it's all about preserving function.
00:42:01There will be a muscle on the inside called mylohyoid,
00:42:04which we're going to need to cut as well.
00:42:07So you can see us opening the jaw.
00:42:13So I can cut through this now.
00:42:23And then we'll be able to swing the jaw out.
00:42:25Now I can get to the back of Julian's tongue where the cancerous tumour is.
00:42:38We want to make sure that as much of Julian's tongue as possible functions normally.
00:42:43Two forceps to me, please.
00:42:45Could you grab hold of that bit there?
00:42:46So I must remove all of the cancer with a clear margin so it doesn't grow bad.
00:42:57So now we're going into the tongue.
00:42:59So unfortunately, the nerve which gives sensation to the tongue on that side is going to go.
00:43:13It just means that the tip of his tongue is going to be numb.
00:43:16He's still going to have taste.
00:43:23Suction, please.
00:43:25So I'm just going a little bit deeper here.
00:43:28So I'm going to come across the base now.
00:43:34Just coming right to the back.
00:43:37And it's right at the base of the tongue.
00:43:49So this is the base of the tongue.
00:43:52And that's where the positive margin was.
00:43:54And we need to get a centimetre on that.
00:43:55That's why we've had to go back as far.
00:43:57So we've removed here almost half of Julian's tongue.
00:44:02And if we don't reconstruct this, he's going to find it very difficult to eat and speak again properly.
00:44:07And his quality of life would be intolerable.
00:44:11So basically, I'm done.
00:44:13Sat's going to have a quick look at the blood vessels.
00:44:19So we're going to use a flap of skin from Julian's arm with its blood supply to reconstruct his tongue.
00:44:26So I've divided the two veins that travel with the artery.
00:44:33And then we'll divide the other major vein.
00:44:39When you're using muscle flaps, the amount of time you can survive without blood supply is markedly decreased.
00:44:51I'll just release this one vein.
00:44:56So here you can just see everything detached.
00:45:01We must connect with the flap as quickly as possible.
00:45:04As the longer it is without a blood supply, the more likely the flap will die.
00:45:08And then we may have to abort the reconstruction.
00:45:16Where is the patient going back to abscess?
00:45:19Oh my God, we're looking for the facts.
00:45:20Obviously, I mean, his health concerns are there.
00:45:35They're more of them now than they are there.
00:45:37Yeah, yeah, yeah.
00:45:37And so now we're going to do the more challenging side, getting the nerve out, it's going to be a little bit more difficult.
00:45:44Is it's going to be close to big vessels within the pelvis and close to bow, which is obviously one of our concerns.
00:45:53Luke's pain is unbearable and it's brought his life to a standstill.
00:45:56We need to locate the nerve at the top of the left thigh to give him the best chance of a life worth living.
00:46:02You okay?
00:46:02Yeah.
00:46:03Happy? Everyone all right?
00:46:04Yeah.
00:46:05We're doing the left side now.
00:46:08This side is slightly more complicated because we don't have the normal landmarks anymore in this side that we would normally follow to get to the nerve.
00:46:16So it's much more difficult to make things even more complicated.
00:46:20This is the area where the nerve is right in front of the bowel and all the big vessels as well.
00:46:29What's that rim?
00:46:30I'm not sure.
00:46:32So there's something sharp here.
00:46:34Can you feel that?
00:46:35Where are my fingers exactly?
00:46:37So you see that thing there?
00:46:39Can you see this here?
00:46:40This is muscle.
00:46:41You see this here?
00:46:42Yeah.
00:46:43I don't know what that is at the moment.
00:46:45The challenge is first finding the nerve.
00:46:50It just can't.
00:46:52This all gets a bit red, doesn't it?
00:46:54You can't quite work out what's going on.
00:46:59Probably like all these things is that everything looks the same.
00:47:02Mm-hmm.
00:47:03I'm finding it's quite hard now because I can't work out where it goes.
00:47:14Every time I do anything, it's just bleeding.
00:47:19That's probably...
00:47:20Everything's at the scene.
00:47:21Yeah.
00:47:22Oh, it's just all red and horrible.
00:47:25There's sort of something there.
00:47:28There's...
00:47:29And I think we've got to find some anatomy that we're familiar with at the moment because...
00:47:38But we're making very slow progress at the moment.
00:47:41Um, I don't feel we're getting anywhere.
00:47:44Luke's anatomy is almost unrecognizable as a result of the bomb blast.
00:47:50We're struggling to identify the correct nerve to operate on.
00:47:53Oh, my God.
00:47:54I might have to stop and look at the anatomy in a second, you know, on the scan again.
00:48:00I'm worried if we can't find the nerve on this left side, Luke's entire operation may have been wasted.
00:48:06I just can't get myself orientated at the moment.
00:48:09Do you want to have a little go?
00:48:10And I'm going to just de-scrub a second because I want to have a look at the scan and get the scan out.
00:48:13Um, I can't find the nerve.
00:48:18So I want to look at the, um, scan again, just get myself orientated.
00:48:23Not sure I've got many more of these cases in me to be nasty.
00:48:26Luke's been under anaesthetic for three and a half hours.
00:48:30Every minute puts more stress on his heart.
00:48:33Time pressure acutely to the surgery now is more because of the anaesthetic risk.
00:48:38There's a load on his heart which is already compromised.
00:48:41So the longer we take, the higher the risk is.
00:48:54Which theater was it?
00:48:5723.
00:49:11The problem is it just can't, uh, can't really difficult to identify anatomy because he's only got half a pelvis.
00:49:28It all looks like scar tissue.
00:49:30I still think it's that.
00:49:31Do you think you've got it?
00:49:32I found something I thought might be it, but I don't know if that's the stump there.
00:49:47I tried cutting it, but it's...
00:49:49The one scanner wanted to look at, I can't...
00:49:53It doesn't say.
00:49:54It's...
00:49:55Well, you just can't see it.
00:49:56Yeah.
00:49:57I'm wondering if it's the other graph.
00:49:58Let me re-scrub.
00:50:00And the problem is the scar looks very much like nerve.
00:50:04Um, it was there before, so it's very, it's quite hard at the moment.
00:50:11I'm cutting away at the scar tissue from Luke's injuries to give me a better view of the nerve that's causing him pain.
00:50:17I was just wondering if this is the stump of the nerve here, and this is the notch.
00:50:30Oh, I see what you mean?
00:50:31Yeah, right there, yeah.
00:50:32Yeah.
00:50:33Yeah, you're right on your...
00:50:34Can you see there?
00:50:35Yeah, yeah.
00:50:36There, that's it.
00:50:37The nerve is here.
00:50:38So, you could go around it a bit more, and then we could cut it then and put some...
00:50:46and, um, just put some muscle around it.
00:50:48Yeah.
00:50:51I think we've got to go on this bit of bone as far as we dare.
00:50:55We can either put some muscle or something in there.
00:50:57Little cat sport, please.
00:51:01And then I think, I think we've got right where it's all scarred up onto the bone.
00:51:05God, yeah.
00:51:07And, um, I, the problem is now, is what I'm a bit nervous about, is that as we, as I pull this, I'm feeling that there's stuff...
00:51:14You're pulling abdominal contents.
00:51:15You know, I'm pulling abdominal contents this way, or certainly peritoneum, so...
00:51:18Yeah, yeah.
00:51:19Because we can't really free it up anymore here without damaging the peritoneum.
00:51:23No.
00:51:24And there's bowel there that is causing us, and lots of big veins.
00:51:27We are now operating deep inside Luke's pelvis, very close to his bowel.
00:51:32There's a risk that we can inadvertently put a hole in it, which could cause Luke lots of problems after surgery.
00:51:38There, look.
00:51:39There, there's some decent muscle there, look.
00:51:41Oh, yeah, yeah.
00:51:42Yeah.
00:51:43So I think, take a bit of that muscle there.
00:51:48So we're taking some, a small amount of piriformis to wrap around the end of the nerve that's quite scarred.
00:51:56We've freed it up as much as we can from the bone, but we can't really go any deeper without risking damage to bowel now.
00:52:02We, we, we want to try and minimize his time under anesthesia if we can.
00:52:07It's not too bad.
00:52:08What time are we on now?
00:52:09Half five.
00:52:10So we're...
00:52:12We've, we've done five hours so far.
00:52:13What we're going to do next is, we're just going to cut the, uh, as much of the scarred nerve as we can,
00:52:18and then we're going to parachute around the end of the nerve this bit of muscle we've just taken.
00:52:24I think what, what we're trying to do is, is hopefully allow the nerve to have some muscle around it that is protecting it from scarring up to the bone again.
00:52:39And that will be really important.
00:52:42That looks great.
00:52:44There's a, there's a few little bits to do, but we're very close to starting to close.
00:52:51And that's it done.
00:52:53We're really hoping that we'll get some relief from this, because at the moment, every time he jolts down onto his pelvis, remembering he's an amputee and has to sit,
00:53:02it jars the nerve, and hopefully this will then stop that cycle.
00:53:08We've got through it. It's really challenging surgery.
00:53:14I'm pleased that Luke's heart has managed to get him through this lengthy operation.
00:53:18This really is the last chance of improving Luke's pain.
00:53:21Hi, Abby, it's Mark Foster. Are you okay?
00:53:33Yeah.
00:53:34Yeah.
00:53:35Yeah, yeah, very good. Yeah.
00:53:36Um, so we just finished. Everything's gone really well. He's fine.
00:53:41Um, hopefully you can rest, um, a bit easier. He's not completely out of the woods as you can imagine.
00:53:51It will now be an eye to you and they'll be able to keep everything, uh, very tight.
00:53:55From my perspective, I just think, you know, you know, we've done exactly what we can.
00:53:58Um, but yeah, it's taken, it's taken its toll today, I have to say.
00:54:02The left side has caused us some, um, not problems so much, but we, I couldn't get as much around the nerve as I wanted to.
00:54:13It's just far too deep. So we've got onto the end, we think.
00:54:16I don't know how successful this will be, I have to say. Um, I think we've not been able to see the nerve as clearly as we wanted to.
00:54:27We're really hoping that we'll get some relief from this.
00:54:43Yeah, go.
00:54:45Keep going.
00:54:46Okay, stop it.
00:54:49What we'll do now, we're just going to move that loop, if we may. That's all right.
00:54:54Feel it.
00:55:03So this is going to be the front and the back.
00:55:05And these two blood vessels we're just going to lay into the neck.
00:55:08Like this.
00:55:09There.
00:55:10The skin that we've used to reconstruct the tongue is quite thick.
00:55:15The problem is it's so thick that it needs a blood supply.
00:55:19Without this blood supply, basically the flap would die within a number of hours.
00:55:25And it's got to have an inflow and an outflow.
00:55:28And we're just going to start insetting the skin here.
00:55:31Three ovicral, please.
00:55:33If we don't get this plumbed in in a timely manner, the skin will start to die off.
00:55:38If the skin flap dies, then the reconstruction wouldn't work.
00:55:41Well, that would mean that Julian would be left without a functional tongue.
00:55:44And this would affect his ability to speak and eat.
00:55:46A 9-0 stitch.
00:55:47So the stitch we use, as you'll see, is quite small.
00:55:51They're about one and a half, two mil.
00:55:56This is where you see how badly we all shake.
00:56:00You try and get a nice little stitch in.
00:56:03Got to be a bit careful.
00:56:04I've just lost where I am.
00:56:06There's one more, I think, just at the top.
00:56:09Just got to kind of pull that.
00:56:12There.
00:56:14That's it.
00:56:16It's all right.
00:56:17This is the last stitch.
00:56:19So that's just tying this off.
00:56:22And then I think, fingers crossed, we'll be done.
00:56:27It looks quite nice here, doesn't it?
00:56:29The important thing is the artery and the neck, you can see pulsating really well.
00:56:35So you've got a lovely pulse.
00:56:36You can see how you've got a good pulse going into the flap.
00:56:39Into the flap.
00:56:40I think, fingers crossed, so hopefully it'll be watertight.
00:56:46And you'll be able to just lift it up.
00:56:48All we've got to do then is just close it.
00:56:51With the flap now in place, we can start putting Julian's jaw back together again.
00:56:55So we're going to be using metal plates and screws to hold the jaw in place.
00:57:02So we're not doing this rigid yet.
00:57:05We're just going to get these screws on one more thing.
00:57:08We're going to plate it together and then I'll just try and get the stitching at the back.
00:57:12So, needle to you, thanks.
00:57:14Screw, please.
00:57:16Manipulate it into a good position and tighten up.
00:57:20So his teeth are in a good a bite.
00:57:27That's it.
00:57:28And you'll feel it lock.
00:57:30But the jaw is all together in one piece.
00:57:33And we've got that skin on the side of the tongue going right into the back.
00:57:39So what we need to do now is just a little bit more closing here.
00:57:43The skin stitches should really just be gently holding together what your deep stitches have done.
00:57:51The patients have no idea what you've done on the inside.
00:57:55They don't know if you've done a good job or a bad job.
00:57:58So all they see is the stitching that you've done.
00:58:01And if your stitching looks poor, then quite rightly, they've probably got to think to themselves,
00:58:06well, hold on.
00:58:08If they're not that bothered about what it looks like on the outside,
00:58:12what have they done on the inside?
00:58:18Happy guys.
00:58:20Ready, steady down type of thing.
00:58:22Ready, steady, slide.
00:58:25I never say it on the dial.
00:58:28But before we come off the red, I want to come off the red.
00:58:31You just relax, Julian.
00:58:32Just let everyone do the work for you.
00:58:34You just lie there and relax.
00:58:36It's all gone well, OK?
00:58:38You just relax and let Yasmin do all the work for you.
00:58:46You walk away thinking there shouldn't be any problems.
00:58:49However, you never know.
00:58:50You never know.
00:58:51Really, until the patient goes home, which will be about 10 days time,
00:58:55you never truly relax.
00:59:14Good morning.
00:59:20Great, so we're going to see Luke today.
00:59:28He's two weeks following his surgery now.
00:59:31It's been a bit of a bumpy road, actually, following his surgery,
00:59:36certainly with lots of conditions that have kind of revealed themselves as we've gone on.
00:59:42But, yeah, we'll see how he is today.
00:59:45Knock, knock.
00:59:46Hello.
00:59:47Hello.
00:59:48Hi.
00:59:49Wow.
00:59:50We've got everybody here today, including the frog.
00:59:52Excellent.
00:59:53Great to see you.
00:59:54Good to see you guys.
00:59:55Nice to see you again.
00:59:56Hello.
00:59:57You all right?
00:59:58Hi, Dad.
00:59:59You all right?
01:00:00Yeah, very good.
01:00:01Brill.
01:00:02So, I think we're two weeks down the line now.
01:00:06It's been a rocky road with pancreatitis, PEs that we've had.
01:00:11And you've had some problems on one of the days of developing a chest infection as well.
01:00:16Yeah.
01:00:17And that really put you back a little bit.
01:00:19And your pain's been intermittent over that time.
01:00:22Yeah.
01:00:23But last day or two, I hear that things are getting a lot better.
01:00:26I'm good.
01:00:27How are you feeling?
01:00:28I'm good.
01:00:29The pain that I'm getting is more from the scar, I think.
01:00:33I am getting a bit of nerve pain on the right, but nothing drastic.
01:00:39No.
01:00:40So, I think it's more just from the wounds.
01:00:42Yeah.
01:00:43Touch wood.
01:00:44Sure.
01:00:45And then the left side?
01:00:46Left side's fine.
01:00:47Yeah.
01:00:48That's quite surprising for me, actually, that the left side has been done so well.
01:00:52And because we pulled quite a lot of the nerve away from bone and the scar, then that would
01:00:57probably explain why, actually, that's done okay.
01:01:00Yeah.
01:01:01Whereas the right side was very much a fresh cut through the nerve.
01:01:03Yeah.
01:01:04That's why it really does cause a bit of pain to start with.
01:01:06But then that's eased now.
01:01:07Great.
01:01:08We won't really know whether it's absolutely worked for a number of weeks yet.
01:01:13Yeah.
01:01:14Maybe for months.
01:01:15It's just to see how it goes.
01:01:16I think, you know, as every week goes on, every month goes by, that's a good sign that
01:01:21we'll get things.
01:01:22Yeah.
01:01:23And what happens is the nerve's got to grow down.
01:01:24It's got to re-innovate.
01:01:25Right.
01:01:26And that does take weeks to happen.
01:01:28It's early days.
01:01:29I don't want to give you any false hopes.
01:01:31Yeah.
01:01:32But I think, you know, we're going to go the right way.
01:01:35And then, you know, I think the hard work for you is now on as well.
01:01:38We want you to, you know, really get yourself as healthy as you can.
01:01:41Yeah.
01:01:42That will help everything settle down.
01:01:43Yeah.
01:01:44Help the pain that was happening not re-establish itself.
01:01:48Yeah.
01:01:49On behalf of my family and Abby and everybody else, I'd like to thank you and the team for
01:01:54the great job you've done with me.
01:01:56It's a team effort.
01:01:57Absolutely.
01:01:58I have to say, I felt I've earned my money with you.
01:02:01It's truly amazing, isn't it?
01:02:03We probably wouldn't have Luke if it weren't for you guys.
01:02:05All right.
01:02:06Well, it won't be goodbye.
01:02:08I know what this is like, Luke.
01:02:09So, we'll see you in a few weeks in the clinic.
01:02:11Yeah.
01:02:12I think probably about the six-week point.
01:02:14Okay.
01:02:15Great.
01:02:16Catch.
01:02:17I'll meet you later.
01:02:18Yeah, thanks for that.
01:02:19Cheers.
01:02:21I'm excited.
01:02:22Hopefully, I can get back home today.
01:02:25There's good news about my surgery.
01:02:29I think this one might be the one that works.
01:02:33I've been, I've had about four or five days now where I've not really had any pain.
01:02:37It's like, it's completely flipped it on its side.
01:02:40So, it's quite mad to see.
01:02:42He's definitely turned the corner now as we hoped and predicted.
01:02:50Yeah.
01:02:51So, he's doing much better.
01:02:52His pain is now really settling.
01:02:54And I think we, I would expect him now to have a good period of relief.
01:03:00You can see from him that he's dramatically different.
01:03:04This has made a massive difference in just in the short term now.
01:03:07I think we're all very cautious.
01:03:11I've been through this with Luke a few times now.
01:03:14I'm, I'm, yeah, I'm really pleased with how he is.
01:03:18I'm really pleased for him.
01:03:20We're always humbled at being in these scenarios.
01:03:23We don't really do it for, for the reward.
01:03:26We do it because it's the right thing.
01:03:36Hi, Julian.
01:03:39If you come into my clinic over here, I'll have a good look in your mouth.
01:03:43And just touch base with you about where we stand.
01:03:50You did remarkably well.
01:03:53Obviously, the star line doesn't look particularly good at the moment
01:03:55because you've got hair growth around it.
01:03:57So, you've got a little bit of, you've probably seen yourself,
01:04:01that the skin is just overlying and overlapping a little bit underneath.
01:04:06And all this neck is going to settle down.
01:04:09The bit that we really want to get right when we stitch it together,
01:04:12is that little junction between your lip and the skin.
01:04:15And that's spot on.
01:04:17But should I have a look inside your mouth?
01:04:19So, if you come and make yourself comfy, I'll put some gloves on.
01:04:22So, I'll have a quick peek inside if I may.
01:04:27Just open a little bit for me.
01:04:29So, we did go a long way back, actually.
01:04:32You can let your tongue relax.
01:04:34Let it all go soft and floppy.
01:04:36So, I can see the flap at the back.
01:04:38You've got some purple stitches in there.
01:04:40We've got the skin there.
01:04:42Always swells up a bit.
01:04:43I'm just going to pull it right back.
01:04:45It's looking really nice.
01:04:47Everything's going the way it should be.
01:04:49Statistically, the most likely outcome is going to be, you know, all being well.
01:04:55No residual cancer.
01:04:57There are things you probably weren't expecting, but this will go the right way.
01:05:02Lovely.
01:05:03Lovely.
01:05:04I'll let you go.
01:05:05You have done remarkably well.
01:05:06As I say, it is going to be peaks and troughs.
01:05:08It's all about regaining as much form and function of my tongue as I can.
01:05:12And, you know, you've done an amazing job on that.
01:05:14You know it's a team.
01:05:15Thank you so much.
01:05:16Cheers, mate.
01:05:18Alright, I'll let you go.
01:05:19Cheers, Julian.
01:05:20Thank you very much.
01:05:21I'll let you go.
01:05:23All the best.
01:05:24Cheers, then.
01:05:25See ya.
01:05:26Bye now.
01:05:28The main thing for me was quite simply was how this graft took on my tongue.
01:05:36Tastes all right, actually, amazingly.
01:05:38So it hasn't really impacted my taste, which is great.
01:05:41Tell them for you, okay?
01:05:43Oh, it's so good to get that off.
01:05:45I bet.
01:05:47It's all stepping stones for me.
01:05:49This now sets me off on my journey to getting back to health.
01:05:53Get through this major, major surgery and come out the other end okay.
01:05:57It's huge.
01:05:59Yeah, so I'm really happy with that.
01:06:02Okay.
01:06:09Not everyone will survive a heart operation,
01:06:11but this operation is really the only chance that Matt has.
01:06:15And the heart is out.
01:06:16All the breast has been replaced by the tumour itself.
01:06:21We are racing against time.
01:06:26It's possibly one of the most significant moments of her life.
01:06:29We are in the tumour now.
01:06:31This is inside the belly of the beast.
01:06:33It's broken inside the bu estado.
01:06:34It's inside the belly of the beast.
01:06:35The most significant moments of her life and they've reached me.
01:06:36Took you back the tumour in the tumour.
01:06:39This is how we do that.
01:06:54Transcription by CastingWords
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