'Amazing' innovative procedure at St. Luke’s saves man's leg and back walking on his own

When Lance Linderman thinks back on everything he and his left leg have gone through, he can’t help but laugh a bit realizing just how long it’s been.

“Well, it all started in 1995 …,” he said with a chuckle.

A journey that started almost 30 years ago in southeastern Washington, when a dirt biking accident caused a tailpipe to go through his tibia just below his knee, led to an innovative solution in Meridian and saved his leg.

“I had so many surgeries where I was prepared by the surgeon, that if things went wrong, they may have to make the decision to amputate and I may wake up without a leg,” Linderman said. “There were times I almost made the choice to have them do it, but luckily I met some pretty great people at St. Luke's.”

After multiple procedures in Washington, Linderman was in a cast for 11 months. Six months after that, he had an infection that was seemingly cleared up after a robust round of antibiotics.

Diagnosed with multiple sclerosis in 2011, the wound flared up soon after he began taking medication for his MS. It continued on and off until the summer of 2020, when the pain became too much and Linderman visited St. Luke's Eagle. He was soon taken to the emergency department in Meridian.

Dr. Kaitlin Neary performed an operation that cut out the damaged bone July 20, 2020. It was approximately 6 inches' worth, and a rod was put in until he was healthy enough to have a 3D-printed spacer put in. He couldn't put any weight on his leg for three-and-a-half months until the procedure.

But about six months later came another infection.

“It had been so hard on me and my family, I started thinking about amputation again, especially if they were going to have to go above the knee,” Linderman said. “You never knew if the last one would work. But Dr. Neary said there was one possibility how we could save it.”

Dr. Louis Poppler had been aware of Linderman's case and Dr. Neary called him in for what he calls a “Hail Mary.”

“She's a very progressive foot and ankle surgeon and a bone graft wasn't going to work, but we discussed another option that to my knowledge hadn't been done in Boise,” said Dr. Poppler, a reconstructive surgeon.

The procedure? Take a piece from Linderman's right leg and transplant it into his left leg, with its blood supply and immune capabilities. Called free vascularized tissue transfer, it would hopefully provide an immune response, and eventually let Linderman begin building bone strength again.

On Feb. 8, 2022, the surgery was performed at St. Luke's Meridian. It took approximately 18 hours, during which Poppler took a piece from the middle of Linderman's right fibula, keeping the portions supporting the ankle and knee intact.

“It was very exciting because Lance was not only a great patient, but it also was the payoff in St. Luke's building a strong plastic and reconstructive surgery program,” Poppler said. “Having it be successful would prove the value of our program's importance.”

Linderman spent two weeks in the hospital, including a week in the ICU, and 10 days at Aspen Transitional Rehab. For four months, his leg was kept straight. As he healed, Poppler had him do exercises, putting 5 pounds of weight at a time to stimulate the bone, along with consistent work at Wright Physical Therapy. Even though the first time he tried to bend his knee, he only could do it 2-3 degrees, progress was slowly being made.

“My goal was to walk into my 9-year-old daughter's classroom and meet her third-grade teacher,” Linderman said. “When she was in first grade, I was in a wheelchair. Same with second grade. But in August, I could put 100% weight on it for 15 minutes a day.

“It was the second to last classroom down the hall, so I figured ‘five minutes there and five minutes back, I should be OK.’ And I did it. Holy cow, did it hurt, but I felt better pretty soon after.”

“My wife thought it may be a bone infection, and I was really hoping she wasn't right,” he said. “… well, she was. It was the worst-case scenario.”

To see Linderman's progress has been a point of pride for Poppler, but also the whole team around him. He praised Neary, along with recently retired Meridian surgical director Melissa Winters for getting the necessary equipment in place, operation room staff, anesthesiology and ICU nurses.

“He'd essentially been debilitated for years, but he's back to doing everything he needs to, better than he ever has, back on his MS meds, too, so that'ss been wonderful,” Poppler said. “Different teams and disciplines coming together to expand what we can offer. He's a success story for the whole Meridian team.”

For Linderman, he has continued to get better and better. He can walk around on his own with only a slight limp that he is working on fixing. He counted the number of appointments he had between July 7, 2020 and July 7, 2022 — 362 of them, almost one every other day for two years.

“I am so thankful I live where I do, I moved down here at the end of 2018 from near Lewiston — if I was still there, I probably wouldn't have my leg. I would not have been able to make that many appointments or get this level of care,” he said.

“I'm pretty darn happy with the medical system here; it’s been unbelievable. Dr. Neary has been incredible, Dr. (Martha) Cline, my neurologist, has done wonderful things with my MS, and Dr. Poppler, what he did was amazing. The way everyone communicated and made it happen is unbelievable.”

Linderman also wanted to praise the team at St. Luke’s Clinic – Wound and Hyperbarics and all the nurses who helped him at the hospital following the procedure.

As for Poppler, he's a Boise native who returned to his hometown three years ago after fellowships at the Mayo Clinic and Washington University in St. Louis, learning from microsurgeons around the world along the way. He had performed procedures similar to Linderman's before, but to do it for St. Luke's was special.

“When we were discussing it being a possibility, I was telling colleagues ‘we can do this in Boise,’” Poppler said. “Showing it can be done safely here, I think that will make a big difference for patients in the future.”