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Cambodian girl starts down long road of surgeries

Lose the lower leg or live with a knee that will not bend, doctors tell Sithan Liam

DOCTORS at the Shriners Hospital for Children are performing the first in a series of surgeries today that could help a Cambodian girl walk for the first time.

Donations from Star-Bulletin readers and others helped bring Sithan Leam, 14, to Hawaii for treatment at the Punahou facility. She suffered a severe burn as an infant, and when it healed, her foot and calf were fused to her thigh.

The treatment will involve three major surgeries and physical therapy. It will be painful at times, and because her knee did not develop properly, her left leg will be fused straight. But if all goes well, Leam will be able to walk on her own two legs.

JAMM AQUINO / JAQUINO@STARBULLETIN.COM Sithan Leam, 14, held the hand of Shriners Hospital evening supervisor Denise Weatherford while touring the hospital last night. CLICK FOR LARGE WHAT'S NEXT FOR SITHAN » In a few months, doctors will operate again to straighten Sithan's left leg and fuse her knee straight. Her knee and ankle joints did not develop properly and cannot be saved. » In between surgeries, Sithan will be doing physical therapy, which consists of exercises to strengthen her hip and thigh muscles. Shriners Hospital also has a program to teach her English. » Doctors will decide whether to lengthen her left leg or shorten her right leg so the two are even. » If there are complications, it is still possible that Sithan's leg will have to be amputated at the knee joint. Possible complications include failure of an artery supplying blood to her lower leg. » After more physical therapy and follow-up care, Sithan will return to Cambodia in about a year to 18 months. She will live with a host family in the city of Siem Reap, near the famed Angkor Wat temples, where arrangements have been made to send her to school. Medicorps, the nonprofit group that brought Sithan to Hawaii, has set up a fund to help pay for her educational expenses. Star-Bulletin staff

Sithan Leam, 14, suffered a severe burn as an infant. There is no medical care in her village, and when the wound healed, her foot and calf were fused to her thigh by scar tissue.

Since she arrived in Honolulu in February, Leam has gotten to go to beach and see some of the island but prefers to spend time at her host family's apartment near Shriners, watching Korean soap operas at night.

She has gained 12 pounds but not because of fast food. "She could only take one bite of a hamburger," said Sary Kong, Leam's surrogate mother here. "She thought it smelled funny."

But Leam's time here has also involved a difficult decision -- especially for a 14-year-old.

Dr. Ellen Raney, chief of staff at Shriners, said the staff wanted to make sure Leam understood her treatment options.

They showed her the Ilizarov apparatus, a scary-looking series of metal rings, rods and pins placed through the bone, and Leam met patients at Shriners who are being treated with it.

In short, the options were:

» Do nothing and send her back to Cambodia without surgery.

» Amputate her leg at the knee and send her back with a prosthetic.

» Take the longer, more involved and more painful process of trying to save the leg.

Amputating would mean Leam could go home sooner -- probably in three months. But there is concern about whether she can continue to get prosthetics in Cambodia. A good prosthetic can cost several thousand dollars and needs to be replaced every year for children and every few years for adults.

Saving the leg will mean Leam will not need a prosthetic. But because her knee and ankle joints never developed properly, Leam's leg will be fused straight -- she will not be able to bend it -- a potential problem in Cambodia, where many people sit on the floor. There will also be scarring on the leg, and she will have to stay here for up to a year and a half. Part of her foot will also be amputated.

As late as Sunday, Leam's host family talked it over again with her to make sure she understood the choice that ultimately only she could make.

"Your leg will be 'trong' -- straight," said Anthony Deth, brother of Rinou Kong, Leam's host father. "They have prosthetics that can bend," he told her in Khmer.

But Leam was resolute.

"I think the only thing she wants is to save her leg," Deth said.

So today, Raney and plastic surgeon Dr. Clyde Ishii will begin to separate the scar tissue that connects her calf and thigh.

Leam will go through three major surgeries and a number of smaller operations, Raney said.

Her next major surgery in a few months will involve straightening her leg and fusing her knee joint. They will also attach the Ilizarov apparatus.

There is also the possibility of complications. If the blood flow to her lower leg cannot be maintained, her leg will be amputated at the knee, and she will be fitted with a prosthesis.

The last surgeries will involve either lengthening her left leg to be even with her right leg, or shortening her right leg.

The process will be painful at times, Raney said.

"We try to minimize the pain, but you can't completely eliminate it," Raney said.

"I think the children are very brave," she said. "It's got to be hard for her being away from home for so long."