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Cosmetic limb lengthening London by Athens BJR and Dr. Dimitrios Giotikas. Learn more at https://www.athensbjr.com/dr-dimitrios-giotikas/ and https://www.giotikasorthopaedics.co.uk/services/limb-lengthening/

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How Does Limb Lengthening & Deformity Correction Work?

In response to a break in a bone, the bone naturally regenerates until the fracture is healed.Limb Lengthening works by separating the bone and pulling the segments further apart little by little, allowing new bone to form and fill in the space. As the bone segments are slowly lengthened, regeneration results in an increase in length. The limb lengthening procedure is performed with a device called a fixator. The limb lengthening doctor uses a variety of fixators and they can be divided into two categories: the external fixator and the internal fixator or implantable lengthening nail. External fixators are devices that attach to the bone through wires and pins. The external fixator looks and acts like a scaffolding, supporting the separated bone. There are several screws that hold the wire tight against the bones to keep them in place. The fixator mechanically lengthens the limb by pulling the segments of bone apart. There are two types of external fixators: monolateral and circular.The limb lengthening process is divided into two phases: distraction phase and consolidation phase.

Limb Lengthening Surgery

During the limb lengthening surgery, an osteotomy is performed: a surgical cut of the bone. Once the bone is separated, a fixator is applied. After surgery, patients usually remain in the hospital for two to three days and rehabilitation begins the day after surgery. This includes teaching the patient to get out of bed, move joints, use a walker or crutches, transfers to the chair and toilet, and the use of stairs.Lengthening a limb will begin a few days to a week after surgery. The time after surgery and before the lengthening begins is known as the latency period. It is necessary to wait so that the callus (new bone) can form at the break site.The rate of the limb’s lengthening is approximately one millimeter a day, though it may be faster or slower depending on the tolerance of the bone and soft tissues. To make lengthening more comfortable, this rate is broken into quarter millimeter increments. Orthopedic technologists instruct patients, family members, and caregivers on how to use the remote control device.  limb lengthening doctor  turn the distraction rod on the external fixator one quarter turn (1/4 mm) four times per day.

Deformity Correction

A cosmetic limb lengthening doctor specializes in performing a variety of correction techniques to correct deformities of the bones, joints, and soft tissues. Many of these techniques can be performed in conjunction with limb lengthening.

Epiphysiodesis

An epiphysiodesis is a minor outpatient procedure in which small metal staples are inserted into the growth plate of a long bone (e.g. tibia), which halts that bone's growth completely. This can be used as an alternative to limb lengthening to correct a limb length discrepancy; arresting the growth on the longer leg will give the shorter leg more time to "catch up" and equalize limb length. A hemi-epiphysiodesis is a surgical procedure in which one side of a bone's growth plate is tethered to halt growth on that side, but not the other. This allows for gradual angular correction.

Osteotomy

Osteotomy is a surgical cut to the bone. It is used to separate bone during limb lengthening. Osteotomy can also be used for limb deformity correction with or without lengthening. Osteotomy is used to realign bones and joints by performing a cut at the apex of the deformity.The bones and joints are first repositioned and stabilized with internal or external hardware. An intra-articular osteotomy is an osteotomy performed within a joint (e.g. the knee) and an extra-articular osteotomy is performed on the bone, outside the joint.

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Limb lengthening operation

Limb Lengthening:What is it

Limb lengthening is a surgical procedure for extending the bones by cutting the bone and putting in a metal rod. This is done gradually, so that the bones and soft tissues (skin, muscles, nerves, etc.) gradually increase in length. The process usually takes several months.  Lengthening the limbs below the knee can help with both an acute deformity correction and with gradual correction procedures.

Limb Lengthening:How do limb extensions work?

During the limb lengthening operation, the doctor will cut the bone in two places to create two separate sections of bone. The surgical procedure to cut a bone is called an osteotomy.Additional soft tissue procedures can be performed at the same time as lengthening to prepare the muscles and nerves for the lengthening. For example, surgical lengthening of the Achilles tendon can facilitate tibial lengthening. The doctor will also insert an orthopedic bone lengthener. In medicine, orthopedic extensions that are inserted into the bone are called internal devices. Externally-worn devices, such as a Taylor Spatial Frame or Ilizarov device, are sometimes called stabilizers.

Limb Lengthening:After the operation

After the  limb lengthening operation, the bones are left to rest for five to seven days. The first phase of healing is called the "healing period." After the initial healing period, the patient will adjust the orthopedic device so as to slowly remove the two parts of the bone. This gradual process of slow separation of the two bone parts is called distraction. As the two parts of the bones slowly move apart, new bone forms in the middle. This new bone increases the overall length of the bone. The new bone is called a regenerated bone . The patient (or family member) adjusts the orthopedic device every day so that the bone segments are slowly detached about 1 mm (0.04 inches) per day. This percentage may differ slightly for different bones. For example, the treatment plan may be 0.75 mm per day distraction in the tibia, but 1.0 mm per day in the femur or humerus. It forces the body to constantly develop new bones and soft tissues such as skin, muscles, nerves and blood vessels. The distraction phase lasts until the bone reaches the desired length. The lengthening period can take a bit over a month for a length of about 1 inch (2.5 cm) per month. The patient should visit the doctor several times a month during the distraction phase, to make sure that the  limb is lengthening at a reasonable rate.  Based on the appearance of the regenerated bone on X-ray, the doctor may speed up or slow down the rate of distraction. Throughout the distraction process, the patient should attend physical therapy two to five times a week.

Limb Lengthening:Consolidation phase

The limb lengthening distraction phase is followed by the consolidation phase. The regenerated bone hardens slowly. In a typical 5 cm (2 inch) elongation case, it will take about 2 months to reach the length, but an additional 2 to 3 months for the new bone to solidify. In this example, the extension device will remain in place for at least 4 to 5 months. The new bone will not harden and calcify until the regenerated bone has healed. A patient can help bones heal by avoiding nicotine in any form, following a healthy diet high in protein, and taking vitamin and mineral supplements. During the  limb lengthening stabilization phase, the doctor will advise the patient to start putting some weight on the arm / leg (with the help of crutches or a walker), which will also encourage the bone to harden and heal.   Towards the end of treatment, the patient may stop using crutches. After the patient is healed, the orthopedic extension is removed during outpatient surgery (usually patients don't need to stay in the hospital overnight after surgery). To provide extra protection to the new bone, the doctor may apply a cast or ask the patient to wear a splint for 3 to 4 weeks after removing an external brace. Conversely, when an internal device is removed after a bone has been lengthened, no cast or splint is applied.

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