Cosmetic Lengthening
   
 

SMETIC LENGTHENING

 

Limb Lengthening is a complex process that has traditionally been performed primarily on children to correct Limb Length Discrepancies. It has also been an option for people with dwarfism to gain additional height.

More recently, the procedure has been used to give people with Constitutional Short Stature few extra inches of height. The term Constitutional Short Stature refers to people who are in the bottom fifth percentile of height in their region and do not display any deformities common with dwarfism.

Cosmetic Leg Lengthening procedures can not be compared with more simple plastic surgery options. They are very complex, painful, costly and require long recovery times from one half to one full year. People considering this procedure must be fully aware of the pain and discomfort associated with it and must be mentally prepared for the duration. Since anti-inflammatory pain medication can disrupt the creation of new bone, some doctors prescribe minimal pain management. Some medical centers require that the patient undergo a psychological evaluation to ensure they will be able to endure the recovery, with the necessary positive attitude.

 

Please see below the various procedures of Limb Lengthening:-

a) Basic Procedure :- Ilizarov using ring fixators

There are three stages of limb lengthening procedure:

First is the operation, during which the Osteotomy and the reliable fixation with the special ring fixator or monolateral rail fixators.
The second is the stretching period. Our technology allows to make about 1 mm stretching a day.
The third is the consolidation period. It is continued approximately as the double lengthening time. At the end of the consolidation period the device is removed from patient's leg. The procedures are usually performed separately, consecutively for both legs. In some cases simultaneous lengthening may be possible.
The maximum possible increasing is between 7-9cm. During the treatment the patients are active, the day after operation all of them find it easy to move about without any help. The functions of legs are saved because patients can do movements at all period of the procerdure. To perform the procedure patients must stay all treatment time at the clinic. If patients follow advices of doctors there are not any side effects of operations. We had not any serious complications at our Center after all legs lengthening and legs straightening operations.
Even though Ilizarov procedure is very well known for its versatitlity and long term proven results, many patients hesitate to undergo this procedure due to a) Bulky external frame b) pin-site associated infections c) social probems, d) maintenance of the apparatus e) soft-tissue scarring etc.

b) New Procedures:-

There have been many developments in recent years that improve upon the Ilizarov External Fixator device. Most of these developments involve internal devices that either provide more support during lengthening and strengthening, or eliminate completely the need for the cumbersome Ilizarov device. Some of these newer devices are ORTHOFIX ISKD ( Intramedullary Skeletal Kinetic Distractor), FITBONE, Fixator assisted LON
(Lengthening Over Nails) methods.

ISKD (( Intramedullary Skeletal Kinetic Distractor)

 
 

The ISKD is a unique concept in limb reconstruction that has greatly improved the potential to lengthen limbs. The ISKD combines the advantages of intramedullary stabilization with the mechanics of external distraction in one device, offering the ability to lengthen up to 8 cm with a simple nailing technique.

Implanted after osteotomy, the ISKD lengthens gradually in response to normal movements of the limb. The ISKD is designed to distract when rotation occurs at the osteotomy site.Because the ISKD is completely internal, the potential risk of infection is reduced compared to lengthening procedures that require external pins or wires. In addition, there is no scarring from pins moving through the soft tissues.

The ISKD is designed to lengthen for a predetermined distance and then stop. A range of sizes are available to offer lengthening for most patients.

The ISKD is indicated for limb lengthening of the tibia and femur and is used for a)Post-traumatic lengthening b) lengthening following acute shortening c) lengthening in cases of congenital shortening, d)as an alternative to closed shortening.

The surgeons benefits are a)lengthening with a simple nailing technique, gradual callus distraction provides a natural lengthening process b) lengthening in cases of congenital shortening c)mechanical alignment and stability is maintained during lengthening and throughout consolidation.
 
 

FITBONE ®

This is a fully implantable distraction system which gradually increases the distance between two bone segments through a telescope-like device. This miniaturized, mechatronic actuator, which carries the designation "FITBONE ®", also stabilizes the two bone segments after the bone has been seperated to create a reproduction (or "growth") zone.

The internal drive system consists of an electromechanical segment, and an integrated electronic module which receives electric power through high frequency transmission from outside. There is no connection between the implant, and the surface of the human body.

This completely internal feature allows, compared to the commonly used "external" systems, a comfortable, painless treatment in which the risk of infection is virtually eliminated, and reduces the formation of scar tissue significantly. There have been no infection-related complications whatsoever in FITBONE ® treatments up to date. Besides, previous FITBONE ® experiences have shown that the fully internal distraction method reduces the hospitalization period after surgery significantly, so that re-integration into the regular working-, household-, or school life is possible at early stage.

 
 
 
 

Lengthening Over Nails (LON) Methods:-

During the initial surgery, a metal rod is inserted into the central cavity (intramedullary) of the lower legs (the tibia bone), and then the external fixator device is attached to the bone. As the limb is lengthened, one end of the bone slides over the rod and new bone is grown around it. When the bone is fully lengthened, the external device is removed and the rod is surgically attached to each bone segment. During bone strengthening, the rod provides support instead of the more uncomfortable and unwieldy External Fixator Device. At the end of the Strengthening phase, a second operation is performed to remove the metal rod. Lengthening Over Nails decreases the duration of the Strengthening phase by two to three months.

 
 

Summary

Some of the main advantages of Cosmetic Lengthening using internal lengthening devices are a)It is completely internal (no external frame outside the body) b)eliminates pin-track infections c) provides rotational stability d) provides good mechanical allignment during new bone formation and bone re-modelling stage e) no social problems f) minimally invasive and minimal soft tissue scarring.

The major disadvantage of the internal device is the very high cost of the implant used for the surgery. Currently, this procedure is performed only by a selected group of trained surgeons worldwide who use these devices for cosmetic as well as medical indications and this is getting increasingly popular among other surgeons and patients who have realised the vast advantages and benefits of this internal lengthening method. However, we expect that the prices of these implants will drop over a period of time due to the continuous increase in demand for these devices from deserving patients. Hence, Internal Lengthening Nails will be the long term solution for Cosmetic Lengthening as it effectively combines the advantages of well proven, tried and trusted distraction osteogenesis principle ( Ilizarov principle) with patient friendly Internal Lengthening Nail devices.

It is important that you have the procedure done with an experienced limb lengthening surgeon who should explain the treatment,costs as well as the potential complications.The costs will vary according to the method and implants used as well as different centers