MakeMeTaller - The Limb Lengthening Encyclopedia

Please login or register.

Login with username, password and session length
Advanced search  

News:

Show Posts

This section allows you to view all posts made by this member. Note that you can only see posts made in areas you currently have access to.

Topics - admin

Pages: [1] 2
1
Limb Lengthening Discussion / Preliminary concerns
« on: October 21, 2019, 01:13:50 PM »
I would appreciate if people will come here and write there concerns about cosmetic Limb Lengthening. Or start sharing their thoughts and experiences to those people who are in for search.

2
Limb Lengthening Methods / Internal Fixation: Precice
« on: October 05, 2019, 10:55:53 AM »
What is internal limb lengthening?
The lengthening device is inserted inside the bone. The device has a small magnetic motor inside it. When the motor is activated by an External Remote Controller (ERC), the device slowly lengthens. This causes the bone to slowly lengthen.



Previously, the only way to lengthen a bone was to apply a metal scaffold to the leg called an external fixator. External fixators are metal devices that are attached to the bones with special threaded pins or wires. These threaded pins or wires pass through the skin and muscles and are inserted into the bone. The majority of the device is outside of the body.

Please visit Limb Lengthening: The Process for general information about limb lengthening.

What is the Precice and how does it work?
Precice nail in an adult's femurThe Precice Lengthening System (NuVasive Specialized Orthopedics, San Diego, CA) consists of a telescoping metal rod (called a lengthening nail) with a magnetic motor inside of it. The nail is inserted through a small incision into the bone canal (where the bone marrow is found).

<iframe title="vimeo-player" src="https://player.vimeo.com/video/312208449" width="640" height="362" frameborder="0" allowfullscreen></iframe>

The patient is given a special device called an External Remote Controller (ERC) that is used to make the Precice nail slowly lengthen. The ERC has a magnet inside it that rotates. When the ERC is placed against the leg or arm and turned on, the movement of the magnet inside the ERC causes the magnetic motor inside the Precice to slowly lengthen. When the Precice lengthens, the bone also lengthens.

What is the Precice Stryde Lengthening System?
The Precice Stryde nail operates like the Precice nail. The main difference is that the Precice Stryde nail is made of steel alloy instead of titanium. As a result, the Precice Stryde nail allows for more weight bearing, even in the early stages of treatment. This enables patients to return to daily activities sooner. To be on the safe side, we still recommend that our patients lengthening with the Precice Stryde system use crutches.

Will lengthening hurt?
Lengthening with the ERC is so gradual that nearly all of our patients have told us that their leg does not hurt during the lengthening sessions.

What is our experience with the Precice?
The original physician development team for the Precice consisted of Dr. Shawn Standard, Dr. John Herzenberg and Dr. Stuart Green. These doctors worked with a company to produce this revolutionary new internal lengthening nail. Our doctors have been using the Precice system since 2012. The first model that was released was a modular design that was composed of two sections assembled at the time of surgery. The newer model is a single piece, which makes the nail much stronger.

We have found the Precice to be very effective in helping our patients. In the first 100 bones that we treated, 96% achieved the lengthening goal. In another study that we conducted, patients had lengthening with external fixation and then later had lengthening with the Precice. All the patients in the study preferred lengthening with the Precice over external fixation. They said that they had less pain, found physical therapy to be easier and liked the cosmetic appearance of the leg/arm better after treatment with Precice.

Since 2012, surgeons at the International Center for Limb Lengthening have implanted more than 400 Precice nails.

Will the Precice be a good option for every person who needs limb lengthening?
The Precice nail is offered in several lengths and diameters, but a person’s bone may still be too small for it. The diameter of the bone must be wide enough so that the Precice can fit inside the bone canal. The doctor will measure the diameter of the bone on an X-ray. The Precice is offered in three diameters: 8.5, 10.7 and 12.5 mm (0.33, 0.42, 0.50 inches).

The bone also needs to be long enough to fit the Precice. The shortest nail is 6.3 inches (160 mm) for the tibia and 6.7 inches (170 mm) for the femur. The doctor will measure the length of the bone on an X-ray to see if it is long enough to accommodate the Precice nail.

Another factor is whether the ERC can be placed close enough to the Precice to make it lengthen. Soft-tissues (muscle, fat, skin) can be so thick that the ERC cannot be placed close enough to the Precice to activate lengthening. To see if the Precice will work for a patient, the doctor will measure the distance from the bone canal to the skin on an X-ray.

People are not good candidates for the Precice if they have a pacemaker or know that they will need an MRI scan in the next year. It is generally not recommended to have an MRI scan when a person has a Precice nail implanted. Therefore, we routinely recommend removal of the Precice about one year after surgery, provided that the lengthened bone is fully healed.

What about using the Precice in children?
A Precice nail may be inserted in a child’s thigh bone (femur) starting at about age eight years. For the shin bone (tibia), it is preferable to wait until close to skeletal maturity (age 14 years in girls and age 16 years in boys).

How much will the Precice lengthen a bone?
The bone is lengthened in very small amounts each day until the lengthening goal is achieved. The maximum amount that can be lengthened depends on which model of the Precice is used. Different Precice models can lengthen the bone a total of 1.2 inches (30 mm), 2 inches (50 mm) or 3 inches (80 mm). For example, if the shortest Precice is the only one that fits in the bone, the patient may be limited to lengthening a total of 1.2 inches. In most cases, we can implant the models that allow 2 to 3 inches of length.



What should be done to prepare for surgery?
Please visit our Before Surgery section for detailed information. During the visit with the doctor, ask for our guide to prepare for surgery. When planning for Precice surgery, you should also be aware of the following:

Schedule any necessary MRI scans before surgery: The patient may not be allowed to have an MRI scan after the Precice is inserted. An MRI scan could de-magnetize the Precice nail, making it unable to lengthen.
Learn about the precautions that should be taken with the ERC: If any family members have a cardiac pacemaker, the ERC will need to be kept away from them. The magnet in the ERC could affect the functioning of some pacemakers. The magnet in the ERC can also adversely affect items such as credit cards, magnetic room keys and cell phones.
Prepare for the ERC to be loud: When the ERC is being used to lengthen, it is loud! Parents may want their children to become familiar with the sound before the surgery. Watch this video to hear what it sounds like when the ERC is being used to lengthen the Precice:
Demonstration of how the ERC is used to lengthen the Precice

How is the Precice inserted during surgery?
The doctor needs to make space for the device to fit inside the bone. The outer part of a bone is made up of hard tissue, but the inside of a bone is made up softer marrow tissue. The doctor will use an orthopedic drill to create a canal in the marrow cavity in the center of the bone. This canal will be large enough for the Precice to fit inside it.



The way the Precice is inserted depends on the bone and the patient’s unique situation:

For the femur (thigh bone), the device may be inserted in two different ways:
One way that the Precice can be inserted is through the top of the femur that is closest to the hip. This insertion from the hip towards the knee is called antegrade insertion. The illustration below shows how the nail is inserted, the skin incisions that are made, and where the bone may be cut (osteotomy) and lengthened. You can also find a video animation of this surgical technique here.
Illustrations showing antegrade insertion of a Precice nail into the femur for limb lengthening and deformity correction

Another way that the Precice can be inserted is through the bottom of the femur that is closest to the knee. This insertion from from the knee towards the hip is called retrograde insertion. The illustration below shows how the nail is inserted and the locations of the skin incisions and bone cut (osteotomy). Note that the location of the magnet in the femur when the Precice is inserted retrograde is different than when the Precice is inserted antegrade. The location of the magnet will affect where the patient places the ERC on the thigh. When the ERC is turned on and placed against the skin of the thigh, it causes the Precice to slowly lengthen.
Illustrations showing retrograde insertion of a Precice nail into the femur for limb lengthening and deformity correction

For the tibia (shin bone), the device will almost always be inserted from the top of the tibia that is closest to the knee. The illustration below shows how the nail is inserted, the skin incisions that are made, and where the tibia and fibula may be cut (osteotomy) and lengthened. You can find a video animation of this surgical technique here.
Illustrations showing insertion of a Precice nail into the tibia for limb lengthening and deformity correction

For the humerus (upper arm bone), the device will be inserted through the top of the humerus that is closest to the shoulder (from the shoulder towards the elbow).
Illustration showing a Precice nail in an adult's humerus (upper arm)

What happens after surgery?
After the Precice is inserted, the patient will stay in the hospital for 2 to 3 days. Our doctors prefer that the patient stays in the Baltimore area for at least the first 2 weeks after being discharged from the hospital. While using the ERC to lengthen the Precice (called the distraction phase), the patient will need to return to the ICLL for postoperative visits approximately every 10 to 14 days. After the distraction phase of treatment is completed, the consolidation phase starts where the bone solidifies and heals. The patient will need to return to the ICLL every month until the bone is healed.

Physical or occupational therapy is critical during the distraction and consolidation phases of treatment. During therapy, the muscles, tendons and ligaments are stretched in order to ensure that the arm or leg will have full movement after treatment. Patients will need physical therapy if they are lengthening the bones in the legs or occupational therapy if they are lengthening the humerus (upper arm bone). Our doctors may or may not allow this to be done in the patient’s home town, since some people need more specialized physical therapy, which is available at our center. If patients require specialized physical therapy, they will need to stay in Baltimore for that period of time. In many cases, we also prescribe special braces/splints. These are generally made for the patient during the week after surgery.

The patient will be allowed only limited weight bearing on the leg with the Precice in it. The doctor will determine how much weight bearing is allowed on the leg based on each unique situation and the size of the Precice nail that is implanted. If both legs will be lengthened, the patient will need to be in a wheelchair.

Please talk to the surgeon if the patient needs to visit the dentist for routine cleaning or dental surgery during treatment. After the Precice is inserted, special antibiotics may be necessary in order to have dental work.

How is the ERC used to lengthen the bone?
When the ERC is turned on and placed against the skin of the leg or arm, it causes the Precice to slowly lengthen. When the Precice lengthens, the bone also lengthens. The ERC will stop when the patient has completed the correct amount of lengthening for that session.

When the arm or leg is swollen or has thick soft tissues, the doctor may instruct the patient to place the ERC against the skin and apply pressure to compress the soft tissues so that the ERC is closer to the Precice. Magnets work better when they are closer. Panels A and B below show MRI scans of a cross section of a thigh. The red arrow in panel A shows the distance between the ERC and the center of the bone (where the Precice would be inserted). In panel B, the skin and soft tissues are compressed so that the distance between the ERC and the Precice would be reduced (the red arrow in panel B is shorter than the red arrow in panel A).

Two MRIs show how compressing the skin/tissue on the thigh helps the ERC get closer to the Precice

How often will the patient need to use the ERC?
The surgeon will prescribe how many separate lengthening sessions need to be done each day and the amount of lengthening for each session. Typically, patients are asked to lengthen the bone 0.75 to 1 mm each day (0.03 to 0.04 inches; there are 25 mm in 1 inch).

For example, a patient could be asked to lengthen 0.25 mm during four different sessions throughout the day, which would result in a total of 1 mm of lengthening each day. Each session with the ERC would takes about 2 minutes to lengthen the bone 0.25 mm. Four sessions would take a total of 8 minutes per day.

When can the Precice be removed?
Typically, the Precice is removed approximately 1 year after insertion. The removal procedure is an outpatient surgery, which means that the patient does not need to stay in the hospital overnight after the removal. The lengthened bone should be fully and circumferentially healed before considering removal of the Precice.

3
Limb Lengthening Methods / The LON Technique
« on: October 05, 2019, 10:46:05 AM »
The Lengthening on Nail is an external procedure commonly called as the LON is performed by surgically inserting an intramedullary (IM) nail after making a precise hole in the bone which shall be at least 1½ mm in diameter, larger than the diameter of the chosen nail. The length of the nail varies on the height of the patient and is usually chosen to be 3 to 5 cm short of the ankle joint. Standard locking IM nail of a reputed internal brand is used for the procedure.

After the IM nail has been inserted, two screws are inserted towards the end of the nail. An external Ilizarov construct is then fixed to the limb to facilitate the distraction process. Upon the completion of the distraction process ie. 3 months, the external construct is removed.

The benefits of the LON Procedure are:

  • The time period for the external construct is less.
  • Reduced rate of infection.
  • Prevents fractures in the regenerated bone.
  • Minimal scars.

4
Limb Lengthening Doctors / Dr Ian Bacarese-Hamilton - London 2019
« on: October 05, 2019, 10:22:48 AM »
Dr Ian Bacarese-Hamilton - London 2019



Website: http://www.ianbacarese-hamilton.co.uk
CLL Information booklet: http://www.ianbacarese-hamilton.co.uk/pdf/taller-booklet-2019.pdf

About the doctor (from website):

Ian Bac

5
Limb Lengthening Doctors / Dr Leonid N. Solomin (St. Petersburg, Russia)
« on: October 05, 2019, 10:21:42 AM »
Doctor information and response from Dr Leonid N. Solomin, located in St. Petersburg, Russia.



Before we begin to discuss your questions, I ask you kindly to take note of the following.

You should be ready for some inconvenience:
- Our Institute does not provide an official invitation and other visa support. You need to get a tourist visa by yourself. Most we can do: at personal consultation give you an advisory opinion (in Russian!) that you need in the operation and indicate the expected period of stay in Russia.
- The language barrier. Most of the Russian population does not speak English. This applies to the staff of our institute, including administrator and coordinator. All documentation - in Russian.
- The Institute does not have transfer possibilities: from and to the airport, etc.
- The Institute has no hotel.
- Usually Institute cannot provide prolonged stay (because of the large number of patients). Maximum 2-3 weeks. If a longer period is required, it must be booked in advance (without the certainty of a positive decision).
- It would be better to be close to the Institute for whole period lengthening or correction of the deformity. If you cannot extend the period of hospitalization, you should book a hotel or rent an apartment.

Preliminary consultation in outpatient department of our Institute is obligatory! On the basis of this preliminary meeting, we will make a decision about the possibility and expedience of your hospitalization.

Believe me, please - the amount of your questions will be increased after each of my answers. Therefore, after the first three answers I always insist on in-person consultation.

I ask you to kindly understand that our Institute is a federal government organization. First and foremost, we must treat the citizens of Russia. The Institute has a big queue (up to 2-4 months) for hospitalization. Theforefore, I recommend you to order a turn ASAP. To do this, you should tell me about your wish. Within three days I'll let you know the date of your hospitalization. You'll have to come for a consultation 3-5 days before. I work in the outpatient department of our Institute every Wednesday 16.00 - 17.30. If together we will make a decision for surgery, you go to the department in date. If you do not accept the decision, you return home; no penalties for refusing hospitalization.

1) What is the recommended amount to lengthen?
-  On average, 3-6 cm for femur and lower leg: depends on the initial extremity length: the longer the initial length, the greater the elongation possible. The optimal elongation is 18-20% of the initial segment length over one stage, which corresponds to 6-7 cm for the lower leg in an individual of height 175 cm.

Unfortunately the more initial length of bone is, the more lengthening can be done. Excessive elongation of the lower legs make the person look like a heron, excessive increase in the length of the lower extremities, even though the segments are in proportion, results in a "short-armed" appearance. Disregard of these considerations leads to unsatisfactory results.

2) What is the total price and LL methods you can perform?
- We can provide Conventional Ilizarov, LON and LATN as well. Possibility of femoral LON and LATN first of all depends on initial mechanical axis deviation.

Cost: Conventional Ilizarov both lower legs (OR femurs) + 3 weeks in the hospital = ~$3-5,000.  LON, LATN ~$3-8,000.

If larger lengthening is necessary we use cross-elongation.

Sequential cross-elongation of femurs and lower legs:
1st step: right femur + left lower leg
2nd step: left femur + right lower leg
Cost for each step: Femur and lower leg frame applying + osteotomy + 30 days in four-six bed ward = ~$3-9,000.

Between the steps you should completely restore your gait. It takes usually 3-5 months.

Note: These prices are very provisional, because depends on many parameters. Details can be discussed at personal meeting only. Treatment of any possible complications is not included in this account.

Really you can leave the hospital in 10-14 days after the operation (even in 3-5 days). Then all further care can be given to you in your town hospital.

3) What is the recovery time?
~ 4 months - >12 months  - depends on many parameters.

Best Regards,
Prof. Leonid Solomin

Brief Profile (From Website):
1986: Graduated from Blagoveschensky State Medical University
1986-1991: Post-graduate education, specialization in traumatology and orthopaedics
1991-1993: Assisstant of Chair of Traumatology and Orthopedics of Blagoveschensky State Medical University
1993-1995: External Fixation Laboratory Researcher at Irkutsky Research Institute of Traumatology and Orthopedics
1995-1998: Head of Department of Traumatology and Orthopedics at Irkutsky Region Hospital
1996: Doctor of Science
1998-2000: Head of Department of External Fixation at Irkutsky Research Institute of Traumatology and Orthopedics
2008: Full professor of orthopedic surgery
2000-Present: Head of External Fixation Department at R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics (Saint. Petersburg, Russia)

Author of over 350 articles and abstracts, 4 monographs, 46 patents of Russia.

His main field of work is devoted to development, perfection, substantiation and clinical application of external fixation in fractures, non-unions, deformations, defects of long bones, foot and pelvis including congenital and infection problems.

Contact Information:
Leonid N. Solomin, MD, PhD
Professor of Orthopaedic Surgery
Head of ExFix Department
R.R. Vreden Russian Research Institute of Traumatology and Orthopedics
8 Baykova Str., St. Petersburg, 195427, Russia
Phone: +7 (812) 670-8743 / 670-9596
Mobile: +7 (904) 519-3989
Website: http://www.rniito.org/solomin_eng/index.html
E-mail: solomin.leonid@gmail.com

6
Limb Lengthening Doctors / Dr Muharrem Inan (İstanbul, Turkey)
« on: October 05, 2019, 10:21:05 AM »
Here's the response from Dr Muharrem Inan, based in İstanbul, Turkey.  Contact them for specific information and latest updates.

 
1) How many patients have you operated for cosmetic Limb Lengthening so far and How many patients do you operate yearly?

- I have operated on 450 lengthening cases since 1993. 46 of these were cosmetic cases (stature lengthening).

2) What methods do you use for lengthening?

- Classical Ilizarov Technique, LON (Lengthening Over Nails), Lengthening and then Plating, Internal Methods

3) What is the estimated total cost, including post-op treatments, stay, medications, physiotherapy? Are unscheduled surgeries covered and How much does a consultation cost?

- The price package includes 5 days of hospital stay and physiotherapy during this time. The patient then has to pay for accomodation (hotel, residence) and physiotherapy. The patient is advised to do physiotherapy 5 times a week, the physio cost is 1000 Turkish Liras weekly (200 TL per session).

Classical Ilizarov Technique: 30,000 TL
LON: 44,000 TL
Lengthening and then Plating: 44,000 TL
Internal Methods: 150,000 TL

Note: The original prices are in Turkish Lira as stated. Others can convert it to Dollar or Euros depending on the current rate of conversion.  Updated price for internal methods on 8th May.

4) Is there a lengthening limit?

- The ideal lengthening amount is 1/5th of the original length of the bone. The maximum tolerable amounts of lengthening we advise is 8 cm for femurs and 6 cm for tibiae.

5) What is your opinion regarding weightbearing?

- Precice and Fitbone are similar. The patient stays in a wheelchair until the lengthening is complete. We then slowly allow weightbearing with a walker, then with crutches, supported by plastic leg braces. In other systems (External, LON, LATP), we allow weightbearing in as little time as possible.

6) When can a patient return to normal life (walking without support)?

For every centimeter of lengthening, approximately 1-1,5 months. For instance, for 5 cm of lengthening, the patient can return to normal life in 5-7,5 months.



Background (From Website)

Medical School: Osmangazi Medical School-ESKISEHIR- 1986-1992

Residency: Erciyes University 1992-1997

Attending: Erciyes Universitesi 1997-1998

Observer: Lecco General Hospital –Milano/ITALY

Attendant: Baltimore Limb Lengthening Center MD,USA

Assistant Professor

Kurgan Limb center (RTO), RUSSIA

Fellow: San Diego Hospital for Children San Diego, CA, USA- 2003

Associated Professor: Yeditepe University Hospital 2006-2010

Professor: Istanbul university Cerrahpasa Medical faculty Orthopedics and Travmatology 2010-still working

Pediatric orthopedics: Universal German (Taksim) Hospital 2012-still working

Clinic: Istanbul Cerrahi Hospital 2012-still working
 

Contact Info

Address : Ferah Sokak No: 22 34365 Nişantaşı / İstanbul
Telephone : 0212 296 94 50 - 3503
Fax : 0212 296 94 82
E-mail : minan@drmuharreminan.com
Website: http://www.drmuharreminan.com/en/

7
Indian Doctors / Dr Suhas Shah (Mumbai, India) Ashwinii Accident Hospital
« on: October 05, 2019, 10:19:50 AM »
General information about Dr Suhas Shah of Ashwinii Accident Hospital, located in Mumbai, India. Contact for specific information and latest updates.



Brief Profile (From Website):
I have been trained in Ilizarov surgery at the world leading centre, under the able guidance of Prof. Dror Palely at University of Maryland Baltmore, U.S.A. I had also been fortunate to work under the guidance of Prof. Cattaneo & Prof. Catagani (who were the first to introduce Prof. Ilizarov from Russia & his technique to rest of the world) at Lecco, Italy. I have been practicing as an orthopaedic surgeon with super specialization in Ilizarov surgery since last 16 years. I'm visiting as an Ilizarov specialist all over Maharacrapra and have done more than 1400 surgeries in this specialty till now. I have been a faculty member during various ilizarov courses & workshops held all over India. We now have a center for total Orthopaedic care under one roof.

Qualifications
M.S. (Ortho), M.B.B.S., FAIS (Germany), Fellow in Ilizarov (USA, Italy), Consultant Orthopaedic Surgeon & Specialist in Ilizarov Surgery.

Specialties
Trauma, Ilizarov Fixation for Limb Reconstruction, Limb Lengthening and Deformity Correction, Spine surgery, Arthroscopic surgery, Joint Replacement surgery, Fracture and Accident services, Diabetic foot surgery, Polio and Cerebral Palsy surgery.

Awards & Honors
DNB Teacher
P.G Teacher
National Director
Vice President of ASAMI (Association for the Study and Application of the Method of Ilizarov)
ASAMI International Conference Organising Secretary

Why CFIS (Center For Ilizarov Surgery):
More than a 1400 patients from India and the rest of the world have been successfully treated here over the last 16 years. All modern techniques of limb lengthening such as the Ilizarov; Lengthening Over Nails as well as fully implantable nails are used here to tailor the treatment for the individual patient's needs. The complete range of Ilizarov Techniques is practiced here to perfection. Success rates are very high even for complex problems. Several new operations have been designed to help those suffering from Poliomyelitis & Club Feet. It is recognized as a referral center for difficult Ilizarov problems and leading Orthopaedic Surgeons in India refer their problem cases here. Failed Ilizarov cases done elsewhere (in India or anywhere else in the world) are rectified here.

Personalized care and attention is given to all patients. Patients have very comfortable and spacious fully furnished rooms and are provided freshly cooked meals from a special kitchen with ultra-filtered drinking water. The Director of the Center has the unique perspective of being trained by the best - Prof. Dr. Dror Paley, MD, FRCSC, in a Fellowship at the Maryland Center for Limb Lengthening & Reconstruction, USA & Prof. Cataneo & Catagni from Lecco, Italy.

Hospital Services:
Ilizarov (Russian) Surgery, Fracture & accident treatment, Joint Replacement Surgery, Spine Surgery, Arthroscopy Shoulder & knee, Hand Surgery, Ilizarov Angioplasty, Diabetic Foot Management, Physiotherapy, Osteoporosis Detection Centre (BMD test), X-Ray & Sonography, Whole Body Color Doppler, Portable Sonography & Color Doppler, Pathology Collection Centre.

Limb Lengthening Methods:
Cosmetic lengthening of the tibias is recommended a maximum of 7.5 cm with external fixation, LON, or LATP. Internal lengthening with the Precice 2 is also available for both tibias and femurs.

Pricing:
Estimate for bilateral tibial lengthening with external fixation device is $8,000 USD and $9,000 USD for LON or LATP. Internal Precice is $30,000 USD for the nails in addition to surgical costs and doctor fees. Price covers surgery and initial stay at the hospital before discharge.

Accommodation Options:
International patients will have to stay at a hotel after discharge from the hospital, preferably for the duration of the procedure or until distraction is completed.

Contact Information:

Website
www.suhasshah.com
www.ashwiniihospital.com

E-Mail
drshahsuhas@gmail.com

Ashwinii Accident Hospital
Ganesh Apartment, Opposite Sh!taladevi Temple, Mahim (west), Mumbai, 400016   
Phone: +91 (022) 24455155
Mobile: +91 9322235042

8
Limb Lengthening Doctors / Dr. HALIL BULDU - Limb Lengthening Surgery
« on: October 05, 2019, 10:13:08 AM »
I've had that surgery in Turkey 27th Dec, 2018. This surgery is quite popular and success in Turkey.
I talk about my process as someone who lived.
If you interested about that surgery eagerly, i can give you some information&photos&videos about the process.
Contact informations;
iMessage or WhatsApp: +905057764313

My Doctor Op. Dr. HALIL BULDU is one of the most experienced Orthopedic Surgeon based in Istanbul/Turkey.
His patients appreciate the warmth, professional integrity, and open communication that define his medical practice. He is always determined to help his patients, understand their health, so they can be well informed when making important health decisions.
He is one of the most experienced surgeon about leg bone and bone deformities, because of his military backround. Also during Libyan Civil War(Started 2012 and still continues) he saved more than 2000 soldier’s legs and foots while his service in Istanbul.
He still receives private and wounded patients from Libyan Ministry of Health because of his high experience in orthopedic surgeries. Also he is invited to many Tv (Channel D, TV8, MBC4 etc.) for interviews about Limb Lengthening surgery and its features&risks.

EDUCATION
Hospital for Special Surgery, Hand Surgery Dep. (2008)
Istanbul University Faculty of Medicine,
Orthopedics and Traumatology AD. (2006)
Utrecht University, Orthopedics A.D. Holland (2005)
Istanbul University Faculty of Medicine Cerrahpasa (2000)
EXPERIENCE
Florence Nightingale Hospital (2006)
Agrı Military Hospital (2006-2007)
Horasan State Hospital, Erzurum (2007-2008)
Memorial Hospital, Sisli (2008-2013)
Istanbul Cerrahi Hospital (2013- 2017)
Private Clinic (2017-)

Will i have Pain during Lengthening Period?
Other than pain right after your surgery; Answer is NO! Lengthening procedure will be done 4 times a day which will be equal to 1milimeters. So due to its small size, human body can easily adapts to lengthening and pain won't occurs as expected.

What are the risks associated with leg lengthening surgery?
The patient must know this, there is no 100% risk free surgery in the world. Some of the risks; Surgical, Anesthesia, Blood clot (embolism), Infection, Joint stiffness, Circulation disorders or pain due to nerve tension. These symptoms may happen in very low percentages but patient must know it before making a decision about getting this surgery. Tiny infections on the exhausts of the nails are seen in many patients and it is quite treatable without causing serious problems.

Who CAN NOT have Lengthening surgery?
People who has Blood Clotting Disorders,​ HIV/AIDS, Active Infections and BDD (Body dysmorphic disorder is a mental disorder in which you can't stop thinking about one or more perceived defects or flaws in your appearance). Also people who can not fulfill its responsibility during lengthening period.


What kind of leg lengthening surgery methods exist?
There are Ilizarov, Holyfix, LON, Precice, STRYDE methods which are used in limb lengthening surgery. LON is currently the most preferred method by our patients because of its short recovery time and low price.

Which method is included to your package price?
Answer is LON. ​LON means Lengthening Over Nail. A combination of two devices, an internal and external device. Our LON package features;

Lengthening Surgery for both legs (Femur or Tibia)
All necessary medications after surgery
All necessary examinations and tests
5 Days of hospital stay (All Meals Included)
10 Days of hotel stay for 2 person
10 Sessions of Physical Therapy during hotel stay
Airport Transfers
Total Cost is 16000EURO

How does LON Method work?
During the 1st stage of the surgery, an intramedullary nail is inserted into the bone and an external fixator device is attached to the leg from outside. During the lengthening period, the intramedullary nail prevents angular deformity. When lengthening is completed, the external fixator can be removed with the completion of the internal fixation (screw insertion). This method was a groundbreaking development compared to the original method that only involved the use of an external fixator. Even today, many limb lengthening surgeons worldwide use this method.

How many centimeters can I gain with leg lengthening surgery ?
For cosmetic reasons, it is preferable not to lengthen over 6-8 cm per segment. We believe that safety needs to come first. There is no point in trying to lengthen 10 cm per segment. If a patient desires to lengthen 10-14 cm, it is preferable to do 5-7 cm on tibia then 6-8 cm on femurs independently rather than to lengthen 10 cm on one section. The flexibility of your legs is also important. The more flexible your legs are, the more relaxed you will be during the lengthening.

Can I get back my pre-surgery health?
Although this is an operation method, it is completely a cosmetic method. Limb lengthening procedure may take some time, but eventually you can get back your pre-surgery health and do sports that you want. For many sports types, you may have to wait up to 1 year after recovery. The key is to be patient, stick to the instructions of your doctor, do your exercises and care about your overall health.
 
How many scars are formated on the legs after surgery?
It is equivalent to the conventional methods in terms of postoperative scars. While some people are disturbed by the scars, others find them too little to worry about. Nevertheless, those who want can get rid of scars with the help of a plastic surgery.
 
When do I return to my daily life after surgery?
You will get rid of the device in 2-3 months, get well in 4-5 months, return to normal life in 6-7 months. Of course, it depends more on your muscles, nerve structure, flexibility of your leg and the exercises you must do in the process.
 
Can I walk with a device on my legs?
You can walk at home or get out to walk with devices on your legs. It is advisable to walk as long as it is not too extreme. At the same time, you can also do your works that you do not need much to stand up.

What are the difficulties of this surgery?
You will be in bed the first day. 2nd day you can use walker and do your needs. Depending on your situation you will spend 5 days at the hospital. You have to be patient for the first two or three months after the operation. Because every day you will be 1 mm longer. With time, there may be tension on your legs. But this is temporary. After the lengthening is over, the pain is reduced and the tension ends..
Is any kind of preparation needed before leg lengthening operation?
It is recommended to do stretching exercises, go swimming etc. in order to increase the flexibility of leg muscles. Besides physical preparation for surgery, it is equally important to prepare yourself psychologically.

Contact informations;
iMessage or WhatsApp: +905057764313

If you interested about that surgery eagerly, i can give you some information&photos&videos about the process.

Address: Tesvikiye, Fulya Sk. No:5, 34365 Sisli/Istanbul, Turkey

9
Limb Lengthening Doctors / Dr Bagirov (Moscow, Russia)
« on: October 05, 2019, 10:09:03 AM »
General Information about Limb Lengthening Surgery with Dr Bagirov of Clinicanomer1 , based in Moscow Russia.

Pricing

6000-6500 Euro price for surgery and 5-6 days hospital stay.  Additional stay at the hospital is around 80 euros per day.

External Ilizarov Method  (Translated From Russian Text)

In our clinic we perform surgery to lengthen the legs on the basis of low-traumatic techniques using improved layouts Ilizarov fixator. The success of the operation and guarantee its security mainly depends on the quality of preoperative examination. Using computed tomography identifies all the dimensional characteristics of the legs: the length of each leg of each segment, their proportions down to the millimeter, and the state of the hip, knee and ankle joints. The operation is that, after installing the Ilizarov fixator shin, at different levels intersect tibia and fibula. Then with the help of external structures (sets), the patient themselves (with the help of simple devices) stretches shin bone at the intersection. In this growing callus fills widening gap cuts, lengthening bones.

The next day after surgery, the patient gets up and walks alone through "walkers." It is as follows: 5-6 days after start stretching of tissue bone (distraction) dosed by twisting the screws in the device in a certain rhythm and pace, calculated individually for each patient using a special computer program. Temp distraction (stretching) used for extending the legs is 0.5 - 1 mm per day and is a two-or four reception 1/4 turn nuts per day, respectively.

In the elongation zone formed regenerate bone, which increases the length of time during distraction. Later, after the extension period (distraction), it takes time to complete the process of ossification (ossification) of the newly formed regenerate.

Terms of use of external fixation devices depend on the extension of the lower extremities (the larger the value the longer the extension fixation apparatus), and in addition to the individual characteristics of the patient (sxx, age, presence of chronic diseases) and the average of 6 to 12 months.

Very important in this process is itself an external fixator. There are different types and variations of an external fixator, which is carried out by means of lengthening, but almost all of them have a significant disadvantage large dimensions that cause discomfort when wearing limit the movement of the joints. We solved this problem by creating a compact, space-saving arrangement of the Ilizarov fixator clamps with rigid structure capable of withstanding all loads for limb lengthening and does not restrict movement in the adjacent joints and wearing. The entire period of the extension, a thorough inspection by a doctor using X-ray and computed tomography studies. After removal of structures (spokes and rods) are small marks on the skin, but over time they become lighter and almost indistinguishable.

Patient performed independently under the supervision of a physician periodic 1-2 times a month. The number of days required to achieve the chosen patient is calculated as follows: elongation (elongation at 3 cm distraction require 30 days - given rate of 1 mm per day, etc., sometimes stretched over time, the amount is from 0.5 to 1 mm).

Contact Info
Dr Bagirov (Moscow) Clinicanomer1
Website: http://www.clinicanomer1.ru/services/orthopedy/height-increase/
Email:  drbagirov.group@gmail.com
Phone: 8 (495) 641-06-06

10
Limb Lengthening Doctors / Dr Franz Birkholtz (Pretoria, South Africa)
« on: October 05, 2019, 10:08:08 AM »
Updated Response from Dr Franz Birkholtz

:  We do perform cosmetic lengthenings in highly selective cases and LON is one of the techniques we employ. 5cm can be achieved in the tibias in a single procedure, but it is important to note that this is risky surgery and that one can end up with bilateral amputations as a result.

Our rough selection criteria of 165 cm in males as the upper limit. There are cases where, after thorough evaluation, it may be appropriate to perform CLL. This should not be seen as the norm and is definitely not a topic for open discussion.

Methods and Cost of Treatment

Externals (new frames): $30,000 USD approx.
LON/LATN:                   $35,000 USD approx.
Internals (PRECICE):      $52,000 USD approx.

*Dr Birkholtz's lengthening limit is 5 cm for tibias and 6 cm for femurs.

Cost Includes

- All professional fees for surgeon, anesthetist, physio, psychologist, occupational therapist.
- High care unit for 1 day.
- Normal hospital ward for 5 days.
- All followup visits, erc sessions and woundcare visits.
- Daily physio for 75 days.
- Doctor contact at least twice a week.
- Support by a multi disciplinary team experienced in limb reconstruction.
- Accommodation in a four star rated guesthouse close to hospital on a dinner bed and breakfast basis.
- Includes wifi and satellite tv. Also includes daily transfer to clinic for adjustments.
- The accommodation is for two people. This is a self catering unit.

Our lists are generally booked a couple of weeks in advance, but provided I am not on congress or holiday, we can accommodate most of the year.

Cost Excludes

- Cost excludes potential complications.

Consultation Process

Reference: http://www.limblengtheningforum.com/index.php?topic=137.msg5302#msg5302

Background

From his website: Dr Franz Birkholtz studied at the University of Pretoria and currently teaches courses in South Africa and abroad. He is practicing in Centurion with rooms in Lifestyle Management Park next to Unitas Hospital.

As of June, 2012 now does limb reconstruction operations bi-monthly at Vincent Pallotti Hospital in Cape Town. Contact the Cape Orthopaedic Trauma Group (Dr Bernstein) on 021 506 5555 to schedule an appointment.

Practice Number: 0280000226599

Contact Details

Dr Franz F Birkholtz
Orthopaedic Surgeon (MBChB(Pret) MMed(Orth)(Pret) FCOrth(SA))

Telephone: +27(0)12 644 2641
Fax: +27(0)12 644 2642
Website Url: www.walkamile.co.za
Email: reception@walkamile.co.za
Personal email: franz.birkholtz@walkamile.co.za


Postal address:
PO Box 11328
Centurion,
0046
Republic of South Africa

Practice address:
Suite 8C
Lifestyle Management Building
Unit 4
223 Clifton Ave
Lyttelton
Pretoria
South Africa

11
Limb Lengthening Doctors / Dr Robert Rozbruch (New York City, New York)
« on: October 05, 2019, 10:06:57 AM »
Surprised there wasn't a thread on Dr. Rozbruch here.. I just had a consultation with him today and will share any and all info I've learned.

Cost

Dr. Rozbruch said he estimated a total cost for PRECICE lengthening of about $120,000.  About $80,000 in hospital fees, and $40,000 in his fees.  This estimate only includes the surgery, and visits afterwards with Dr. Rozbruch.  As far as removal costs go, he said it is about $7,000 in total.  Should any complications arise (such as nail bending, breaking) he would most likely cover the nail replacement and his surgery fees but NOT the hospital costs (which could run around $80,000). * updated on request

Recovery

Recovery from distracting 6.5 cm with PRECICE will consist of you being in a wheelchair for 5 months- minimum.  Weight-bearing should not be attempted with the PRECICE nail in the early stages.

Consultation

A consultation with Dr. Rozbruch costs $350 EXCLUDING X-rays.  If you want to get x-rays done on the same floor of his facility, you will have to pay $615 for the X-rays if your insurance does not cover it.  I ended up spending over $1000 today as a result (including the blasted parking ticket I got...)  His consultation is good and standard- the only thing I didn't like too much was that because it was an office, I didn't have a lot of opportunity to ask other patients about their experiences with him.

Miscellaneous

If you are still interested after the pricing, you are required to have a psychological evaluation and clearance before being accepted into the program. You would need to make an appointment and see Dr. Ellen Katz Westrich, Tel: 212-946-1739

Contact info

S. Robert Rozbruch, MD
Chief, Limb Lengthening and Complex Reconstruction Service (LLCRS)
Hospital for Special Surgery
Professor of Clinical Orthopaedic Surgery
Weill Medical College, Cornell University
Office Location: 519 East 72nd Street, Suite 204
Mailing address: 535 East 70th Street, New York, NY 10021
tel: 212-606-1415   fax: 212-774-2744
email: RozbruchSR@hss.edu
www.LimbLengthening.com ; www.hss.edu/limblengthening

12
Disclaimer / Disclaimer
« on: October 05, 2019, 10:02:06 AM »
The information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any health care decisions or for guidance about a specific medical condition. Www.Makemetaller.in expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site. By visiting this site you agree to the these terms and conditions, which may from time to time be changed or supplemented by Www.Makemetaller.in. If you do not agree to the foregoing terms and conditions, you should not enter this site.

13
Limb Lengthening Doctors / Dr Shahab Mahboubian (North Hollywood, CA)
« on: October 05, 2019, 09:39:36 AM »
General Information and response from Dr Shahab Mahboubian, based in North Hollywood CA. Contact for specific information and latest updates.



Surgery Methods
PRECICE, Lengthening and Then Nailing (LATN), Lengthening Over Nail (LON), and ISKD
 
If the LATN or LON technique is used, patients can gain 8 cm or more, if their body accommodates the lengthening well.

The most up-to-date procedure uses an intra-medullary rod and is called the PRECICE technique. Most candidates are able to increase their height up to 8 cm with one lengthening procedure (usually femurs) without it being an issue. Additional lengthening of the tibias can be performed to increase height further. And, although age is always a consideration, the main concerns regarding candidacy is the health of your bones meaning that you don't have bone disease or infections. It is not recommended to perform lengthening on the femurs and tibias simultaneously due to higher complication rates including fat embolism, joint contracture and nerve damage.
 
The first step in the process is to determine if the Limb Lengthening procedure is right for you. To do this you will need to set up a consultation so that you can be properly evaluated. During the consultation, Dr. M will examine you and take x-rays of your legs. At that time you will be given all the necessary information including costs, duration and treatment options. You will be able to perform the distraction in the comfort of your own home. You will also not be completely wheelchair bound and will be able to stand and take a few steps for transfers. The recovery time is from 3-4 months before you can walk without any assistance and 6-8 months for competitive sports.

Cost
The approximate cost of the procedure is anywhere from $65K to $75K depending on the procedure, which includes the equipment, surgery fees, hospital fees, and post op visits during the lengthening stage. The entire cost must be paid in advance of the operation.

Contact
Dr. Shahab Mahboubian, D.O., MPH
Email: info@heightlengthening.com or info@llila.com
Website: www.HeightLengthening.comwww.LLILA.com
Address: 10640 Riverside Drive, North Hollywood, CA 91602
Office: (818) 322-0126
Fax: (818) 755-8904

14

Here are the response from Dr Paley Limb Lengthening Institute, based in West Palm Beach, Florida.

1) How many patients have you operated for cosmetic Limb Lengthening so far and How many patients do you operate yearly?

Safety is my number one concern. All of my patients have ended up with normal function after this treatment. I do between 800-900 lengthening surgeries a year of which about 50 are for cosmetic.

2) What is the estimated total cost, including post-op treatments, stay, medications, physiotherapy? Are unscheduled surgeries covered and How much does a consultation cost?
 
The cost of surgery with physical therapy is $80,000 (Precice1) and $83,000 (Precice2) for bilateral femoral lengthening and $95,000 for bilateral tibial lengthening (Precice 1&2). For individuals who undergo femoral lengthening followed by tibial lengthening we offer a package price of $170,000 (Precice 1&2).

3) What kind of physical therapy is assigned to the patient?

Daily PT in our department for the entire distraction phase.

4) What maximum amount of lengthening do you recommend per segment, regarding patient safety? What is the daily rate of lengthening?

8cms femur and 6-7 cms tibia

1 mm daily femur and .75 tibias

5)  What are your opinions regarding the weightbearing of the patients?

WB is allowed to the level of tolerance of the device to make sure it does not break.

6)  How often will you follow up with patients during lengthening?

Every two weeks.

7) How fast can patients return to normal life (walking without support)? What is the time required to lengthen 5 cm and 7.5-8 cm ?

Femurs usually 4 months walking 5 months running and six months sports.    The distraction phase length for femur lengthening is one day for each mm of planned lengthening. E.g. 65mms = 65 days.   We don't start lengthening for 5 days.

Therefore 70 days for 65mms (Precice1) and 85 days for 80mms (Precice2). For tibia lengthening the distraction phase for 65mm is 130 days plus 5 days before we start lengthening (Precice1) and 112days for 80mms (Precice2). Tibia lengthening is ¾mm per day compared to 1mm/day for femur lengthening

Dr Dror Paley
Paley Advanced Limb Lengthening Institute (St. Mary’s Medical Center)
901 45th Street
Kimmel Building
West Palm Beach, FL  33407
Toll Free (888) 888-3873
Email: dpaley@lengthening.us,  inquiry@paleyinstitute.org
Website: http://www.paleyinstitute.org, http://www.limblengtheningdoc.org

15
General Information and response from Dr Donghoon Lee from Severance Hospital,  Seodaemun-gu, Seoul, South Korea. Contact them for specific information and latest updates.


Methods of Leg Lengthening
1. Only using an external fixator
2. Hybrid Techniques (LON, LATN, LOP)
3. Intramedullary Lengthening Devices

Lengthening Over Nail (LON)
- Minimum invasive, minimum scar, correct curvature legs simultaneously
- Established surgical method to minimize x-shaped leg occur
- Product - Internal Fixation; ETN®(Synthes, USA), ASLS®(Synthes, USA)
- External Fixator; Ortho SUV®(Russia), Hexapod®(Germany)

Lengthening And Then Nailing (LATN)
- Rehabilitation period shorten over six weeks compared to LON, possible to return back to everyday life quickly, abundant bone regeneration formation
- First time in Korea, successful LATN method
- Possess the nation’s largest number of cases
- Product - Internal Fixation; ETN®(Synthes, USA), ASLS®(Synthes, USA))
- External fixator device; Ortho SUV®(Russia), Hexapod®(Germany)
- Computer-assisted external fixator device (Ortho SUV®, Hexapod®)   
       
Intramedullary Lengthening Devices(PRECICE®- Ellipse, USA)
- Least scars and pain surgical method, lengthening using only the internal fixator without the external fixator
- Possess the nation’s largest number of cases
       
** Worry-free bone regeneration
- lengthening surgery using combined bone marrow concentration (BMAC) & platelet rich plasma (PRP) therapy which enhances bone regeneration, first established in the world

Recovery
To minimize various complications resulting from limb lengthening, it is recommended that lengthening is performed under 20% of the original bone length, and by an experienced surgeon.

Since the femur is longer than the tibia, generally speaking it is possible to lengthen more when lengthening the femur. However, since the muscles surrounding the femur are very strong, too much lengthening could lead to joint contracture in the hip joint or knee joint, so caution must be taken.

In terms of scars, in the case of the femur, scars near the outer buttocks can be concealed with underwear and all scars (1 cm size) form on the outer thigh, so they cannot be seen from the front or back. They cannot be seen at all if shorts or pants longer than knee length are worn. In the case of the tibia, since scars form on the knee and calf, there is more exposure.

However, over the course of time, these scars fade away, and especially for those with much leg hair, they are not a big problem. In the consideration of scars, the use of internal lengthening nails (like PRECICE) is recommended over external fixators (LON/LATN).

Limb lengthening is a process that involves not only the bone but also the soft tissue surrounding the bone. Especially when muscle is lengthened, even after recovery, sports ability (especially when playing vigorous sports) might not return 100%. The more the bone is lengthened, the more probability sports ability will not fully recover.

According to Park's report (Park HW et al, JBJS, 2008), 25% of the people who lengthen the tibia (6cm in average) was found to have some difficulties in persuing vigorous activity.

If both Tibia and Femur are lengthened sequentially, the maximum to be 10cm in total. But, one more important thing is to consider body ratio. So, I recommend to decide the target considering the safety, recovery of sports activity and body ratio.

My patients need a consultation with me before surgery.

If you have kept up with the exercises (Biking, squats, lunges, water walking, and swimming) for strengthen the front thigh muscle (quadriceps femoris), this will give great help to do the rehabilitation after the surgery. In addition to the thigh muscle exercises, upper-body muscle exercise and stretching exercises as a whole will also help.

Cost (Price valid through 2015)

! All the payments are charged by Korean money unit (Won) or USD.
! You should pay 80% of cost before administration via wire transfer or credit card (VISA, MASTER CARD, AMERICAN EXPRESS) when you go through the administration process.
!This is rough price for bilateral leg lengthening surgery. It can be different for different situations.

What is covered in the cost of surgery?
1) 7 days of hospitalization for each stage surgery (Except LON 2nd, 3rd, and PRECICE 2nd surgery. Those surgery fees include only 3 days of hospitalization. You don’t need to stay in the hospital longer than that). There is a surcharge for patients staying longer than this.
2) Surgery fees.
3) All implants that is necessary for the surgery.
4) All x-rays and radiology fees during hospital stay.
5) Medications and pharmaceuticals during hospital stay.
6) Wheelchair, walker and bedside commode as needed for post surgery during hospital stay.
7) Wireless Internet.

What is not covered?
1) Fees for care worker
2) Fees for stem-cell therapy; cost \5,000,000.; It will be decided when you have consultation with Dr. Lee. It’s not mandatory.
3) Fees for out-patient clinic; cost around \100,000 ($95) ~ \200,000 ($190) for the first consultation including X-ray fee. - may be some variations according to the prescription; If you choose minimal hospital stay in LON or LATN, you should visit out-patient clinic every two weeks during lengthening periods. In case of PRECICE, you should visit out-patient clinic once a week. Lengthening periods takes about 2months - varies according to the length, the type of surgery (LON/LATN/PRECICE) and individuals.

Hospital Charge When Staying Longer Than 7 Days

* Normally Severance hospital does not provide 6 person shared room for international patients. This is special offer for leg lengthening patient.
(Hotel site: http://en.ever8.co.kr/)

Accommodation
Since the hospital fee is expensive, we can introduce long stay hotel near hospital. It costs \100,000 per day (around $100) when using Deluxe room and breakfast is not included. The price for breakfast is \11,000 ($10). This price is for Severance Hospital patient staying more than 30 days. So the price on the hotel website is not the price for our patients.
(Hotel site: http://en.ever8.co.kr/)

Total cost
This is the total cost of each surgery for 90 days of hospitalization including 1st and 2nd surgery. (This is approximate price)


Contact
Website: http://www.drdonghoon.com/ & http://www.bowlegsknockkneesleglengthening.org/
∗ Sinchon Severance Hospital Address : Severance Hospital 250 Seongsanno (134 Sinchon-dong), Seodaemun-gu, Seoul, Korea (Zip Code: 120-749)
∗ Sinchon Severance Hospital Central Resevation Number : (+82) 1599-1004

Pages: [1] 2