THE infection ate away the flesh on his buttocks and thighs, leaving them so decomposed that his pelvic and thigh bones were exposed.

Caused by pressure sores from sitting in a wheelchair for years, the infection also put Mr Amri Mohd Samat, 41, in a coma. He was dying.

That was when two doctors at Tan Tock Seng Hospital (TTSH) decided on a radical move: They amputated the paraplegic from the waist down.

The procedure, called a hemicorporectomy, took 15 hours, and was done in May. It was the first time such an operation has been carried out in Singapore.

Hemicorporectomy is one of the most mutilating surgical procedures, and involves the removal of the legs, genitalia, urinary system, pelvic bones, anus, and rectum.

Similar operations have been reported in the United States, but many surgeons are reluctant to offer it to patients as it is highly complex. It also results in many patients dying - partly from the procedure and partly because of the underlying disease.

Mr Amri is now physically half of what he used to be - but he has no regrets. 'Before the surgery, I was always sick. Although I could not feel the pain of the bed sores, they were bad and smelled, too,' he said.

The bachelor was paralysed from the waist down after a motorcycle accident 21 years ago.

He lives with his brother, Mr Amran Mohd Samat, 43, a technician, in a flat in Woodlands.

Because Mr Amran is out working, Mr Amri learnt to live independently, and got around on a wheelchair.

But years of sitting led to sores building up on his buttocks and the back of his thighs, causing infections that led to headaches and fever. Finally, an infection in late April led to his health deteriorating rapidly.

'The doctor told me I had two choices - to cut off the bad part of my body or suffer and die. I picked the operation because it gave me a 50-50 chance to live,' he said.

After a discussion with his brother, Mr Amri decided to go ahead, and went through psychological counselling before the amputation. On May 8, his doctors went to work.

Dr Heng Chin Tiong, a consultant with the hospital's Division of Surgery, created a colostomy, or opening into the colon from outside the body, to re-direct body waste. He created another opening to drain the urine from the abdomen, bypassing the bladder.

After Dr Heng was through, Dr Mathew Cheng, a consultant with the orthopaedic surgery department, took over.

His job: To amputate the lower half of the body.

Dr Cheng, Dr Heng and the surgical team took 15 hours to cut off and stem all the blood vessels and amputate the lower part of the spine.

The hospital did not say how much the whole surgery cost, but revealed that its endowment fund is helping to foot Mr Amri's bill.

Such a procedure is not for everyone.

'First, the patient has to want to live despite everything, and that was what Amri wanted,' said Dr Cheng.

'Then, he must understand that the operation is complicated and recovery and rehabilitation are long-drawn processes.'

For two months, Mr Amri was in and out of intensive and critical care. It was only last week that he was back at the general ward.

Smiling, Mr Amri recalled coming around after the surgery: 'My first thought was 'eh, still alive. This is my new lease of life and I feel fresh'.'

Mr Amri will move around as he had done before - on his wheelchair. He is looking forward to going home on Friday.

'I can't wait to be discharged. I miss my nephews. I miss my friends. I miss going down to the coffee shop to chat with them,' he said.

juditht@sph.com.sg

LIFE OR DEATH SITUATION

'The doctor told me I had two choices - to cut off the bad part of my body or suffer and die. I picked the operation because it gave me a 50-50 chance to live.'
MR AMRI MOHD SAMAT, 41, who has no regrets even though he is now physically half of what he used to be