Cosmetic Lengthening

Limb Lengthening is not a procedure free from complications .Here is a list of complications **. These are only common complications . Doctor has tried to use simple words for better understanding.

Bone does  not heal ( Nonunion / Delayed union)

The process of limb Lengthening requires cracking of bone surgically ( Osteotomy). This crack is pulled apart to legthenleg . Sometimes this crack ( fracture ) does not heal ( Nonunion) or heals very slow ( Delayed union ). In such circumstances further surgeries like bone grafting , revision of fixation ( addition of nail / plate ) become necessary. The duration of recovery can prolong .

Ankle or knee stiffness and contractures

Restriction in knee and ankle movements may occur after limb Lengthening , they may require physiotherapy and additional surgery. Complete recovery may not always occur .

Nerve Palsy

With limb Lengthening nerves stretch and there can be problem in normal function of nerves . So patient may have pain , muscles weakness or paralyisy, swelling . In most of the cases  nerve problems resolve with surgery or just by slowing down the speed of Lengthening but in rare circumstances they may also not recover .

Infection

Low grade infection of pins is extremely common and many patients experience it when they are going through limb Lengthening. This is treated with oral antibiotics course and it usually settles with medicines .However  there are chances that infection can spread, reach the bone and interfere with healing. The risk is more in presence of internal implants ( Lengthening over nail or plate ). Under such circumstances one or more surgery becomes necessary to treat infection.

Pain

When process of distraction is going on ( when the patient is turning nuts to lengthen his or her limb) there can be pain of stretching or tearing nature . Intensity of pain usually reduces once distraction phase is over. Doctor will give medicines in for pain but it is not possible to make the process entirely painless .

These were some of the serious problems which may occur with Lengthening, there can be some minor issues like difficulty in wearing clothes because of external fixator , difficulty in walking or changing posture, need to do dressing of pins daily, fluid discharging from pin sites.

**Doctor has tried to enumerate the common complications for a common man’s understanding . There can be more complications and explaining all complications in medical terminology is not possible here.

Yes there are some situation where limb lengthening is not advisable.

If a patient is suffering from major psychiatric illness ( like depression or mania ) limb Lengthening is not advisable. For professional athletes and gymnasts it is not advisable because limb Lengthening may adversely affect their performance. Also for tobacco cheweres or smokers limb Lengthening is not safe because bones may  not heal after surgery .

Yes , limb lengthening will leave scars on leg. Doctor will use surgical techniques to decrease the length of scars but it is not possible to eliminate scars completely.

If someone wants to work from laptop then he or she can start working from next day after surgery. But if going to office is necessary then that’s not possible for a few months with ilizarov fixator.

Patients are allowed to sit up in bed from second day of surgery.

Patients are Allowed to stand with walker support and walk up to washroom from third or fourth day onwards but this is not a must . If someone is not comfortable with standing then there is no need to bear the pain and stand up . It’s absolutely perfect to have rest in bed for first two or three months. Usually by the end of two or three months patients have achieved length and at that time they should start taking weight on their legs. First task is to walk inside home for short distances . If they can do it then next is to go to office .At four or five months usually patients can walk independently but at slow speed . standing for long time may not be possible when someone starts walking, itnbecomes possible gradually over a period of months.  Standing causes swelling in legs and feet in nearly all cases, this subsides with rest , elevation of legs and exercices .

For lengthening of any limb the conventional way is to put an external fixator implant on leg . It’s called external fixaror because the implant stays outside leg . The external fixator distracts ( pulls apart ) leg bones to make them longer . The scientific name of this process is distraction osteogenesis . So the doctor will fix leg bone with external fixator ( ilizarov fixator ) and start lengthening from seventh day onwards( distraction phase starts ) . The Lengthening goes on until desired length of leg is achieved  . Once the length has been achieved doctor will ask to stop process of distraction ( distraction phase is over now ). Now you are waiting for the bone to heal completely ( consolidation phase starts and it will end when bone heals completely). The external fixator will have to be removed after bone is healed .

Patient has to wear the fixator for almost six to eight months by this conventional method of limb Lengthening.

Anothet technique of limb Lengthening is to put a nail inside leg ( internal fixator ) and lengthen the leg with external fixator . When the desired length is achieved the external fixaror is removed and nail stays inside to support the healing bone  . This way external fixator can be removed early ( almost 3 months ) and patients can be more comfortable because they don’t have to wear the fixator for long duration like 6 or 8 months . This technique requires additional surgery .

Patients can choose which procedure they want.

Another technique in the field of limb Lengthening is expanding nail  which totally avoids use of an external fixator and lengthening is done with a nail which stays inside leg . Doctor prefers to use the conventional technique of Lengthening which involves use of external fixator .

The advantage of Lengthening over nail ( external plus internal fixation ) is that the patient has to wear the fixator for lesser time which is almost 2 to 3 months as compared to 6 or 8 months in case of Lengthening with external fixator alone . Because the external fixator is removed early patients can be more comfortable and can do exercises in a  better way . The downside of Lengthening over nail is that it needs two surgeries and risk of infection is more than Lengthening with external fixator alone .( Whenever internal implants stays in body risk of infection is more ).  But Lengthening with external fixator alone is also a successful and time tested process and results are equally good .

Usually for four to five days for Lengthening with external fixator and also for  Lengthening with external fixator on nail . If patient decides to undergo lengthening over nail then patient has to come to hospital again for second surgery at 2 to 3 months and stay will be 2 days this time.

Lets understand the answer under two scenarios: 

Scenario 1:

If you have decided that you want Lengthening with external fixator alone then in that case

Doctor recommends that patient should stay in Ahmedabad at least until Lengthening process is going on ( nearly 2 to 3 months) this is because some obstacles can come in way ( pain , swelling , need to teach physiotherapy personally , need to keep a close watch over safety of process ). After this time patient can go to their home city and keep sending x rays monthly , keep doing exercises which have been taught. They have to come back to Ahmedabad for removal of external fixator when bone has healed completely .

Scenario 2:

If you have decided that you want to go for Lengthening with external fixator on nail then also you should stay in Ahmedabad for as long as lengtheninf is going on ( nearly two and half months ) , doctor will keep watch on the safety of process , ensure that patient is doing proper exercises and guide if some obstacles come in the process of lengthening .at the end of 2.5 months you will have to undergo another surgery for removal of external fixator and final locking of nail ( stay of 2 days ). After this you can go to your home city  and keep doing same exercises which have been taught , keep sending monthly x rays .

Cost for patients coming from India is mentioned below :

Cost of Lengthening with external fixator alone ( one surgery ) 2 lakhs.

Cost of Lengthening with external fixator over nail ( two surgeries )  total 2,80,000.

This includes all hospital expenses and implants  but doesn’t include stay and food in Ahmedabad ( we will help you find comfortable and economical place to stay either as paying guest or in a nearby hotel ).

If there is need to do additional surgery for some unexpected occurence or complication then that cost will count as extra and can’t be included in above mentioned cost .

There are two segments in your legs . Upper segment has thigh bone (Femur) above knee joint  and lower segment has Tibia Fibula below knee joint  . Each bone can be lengthened to almost 15 to 25 percent of it’s original length . So right and left tibia fibula can be lengthened to almost 5 to 9 cm .# Doctor will prefer to operate and lengthen lower segment leg bones ( right and left Tibia Fibula )  . It is not advisable to operate upper leg bone and lower leg bone in a single surgery . However if this 5 to 9 cm height is not satisfactory to patient then doctor will lengthen both upper leg bones also ( right and left Femur ) for additional length, but  at a later date. It is recommended that before undergoing surgery for upper leg bones (Right and Left Femur) the lower leg bones should have united.

# these values can change from case to case and there is no guarantee about minimum length which patient will gain, doctor is telling these figures from his experience and knowledge and the intention is just to provide average figures.

We should know that limb Lengthening beyond a certain point will have serious side effects . These are called “limiting factors “for  limb Lengthening. When a person’s legs are going through Lengthening process , joints start to loose movement , they become stiff , sometimes joints can dislocate ( move out of their normal position).  When Lengthening exceeds a particular value , patient may also start to experience tingling and may have weakness or paralysis ( nerve problems ), muscles start having contractures . All these lead to loss of normal function of limb . So doctor will tell you to stop Lengthening when he feels that these problems can start .  Many of these problems can be ameliorated by regular exercices and additional surgeries. In short it may not be possible to lengthen legs as much as one wishes , we can’t lengthen limbs at the cost of their function.

It doesn’t require surgery .There are two options . Removal can be done inside operating room under anesthesia ( patient feels no discomfort ) but it needs half day admission to hospital.  Other option is to remove fixator without anesthesia in normal awake state . Doctor will  be very gentle and slow in removing fixator but some discomfort may still occur because leg is not completely anesthetized . Both options are safe. If there is anxiety about pain and discomfort then patient may choose option of removal under anaesthesia.