Height extension surgery (the process of lengthening the bones and stature) is one of the orthopedic surgeries in which height is increased at the expense of the thigh and leg often, and it is a therapeutic and cosmetic surgery at the same time.
What is stature lengthening surgery?
It is a surgical procedure in which the length of the bones of the legs or arms is increased, and this increase occurs gradually and over a long period of time so that the bones and soft tissues (such as skin, muscles and nerves) after the operation have enough time to grow in length.
The process of lengthening the stature needs several months to show a noticeable result, and it is possible to combine this process with another procedure such as the correction of gradual or immediate bone deformity.
The femur, tibia, humerus and forearm are lengthened routinely and some toes can be lengthened to become symmetrical with each other, adding aesthetics to the foot or treating a deformity.
It is wrong to think that the process of lengthening the stature will lead to an increase in height at the expense of the trunk (ie the chest or abdomen of the patient).
A glimpse into the history of lengthening surgery
Although stature lengthening surgery in its current concept is a recent procedure, the application of this concept in general medical practice dates back more than a century.
In 1905, Dr. Alessandro Codivilla of Bologna was the first to apply skeletal stretching to the limbs in order to increase their length. He relied on several methods through which the bone was lengthened, including pulling the limb forcefully under anesthesia and cutting the oblique osteotomy, all of which were costly, unsafe and Too painful.
In 1921, the doctor Putti proposed the gradual and continuous stretching technique to lengthen the bones of the legs, but the paradigm shift for this type of procedure occurred in the fifties at the hands of Prof. Surgeon Ilizarov, who for the first time placed external annular fixators around the limb to be lengthened and established the principles of the theory of distraction osteogenesis osteogenesis remained the leading theory in the field until the late last century.
Today's lengthening surgery relies on implantable nails that can precisely control the lengthening mechanisms. These nails include the Pliskanov nail 1983, Fitbon's nail 1991, Phoenix's nail 2000, and the most recent of which is Presis 2011.
Increase height by surgery
Increasing height is based on several simple biological principles based on tension stress.
The gradual tightening of living tissue using screws, fixators and other surgical techniques creates a state of instability that effectively stimulates growth and maintains the activity of the cells responsible for it for long periods.
With the availability of sufficient perfusion, this increased tension with time will lead to the activation of vital processes and regenerative reactions that end with an increase in length according to the direction of tension.
The increase in bone length after the process of lengthening the stature includes four stages:
- latency phase: It is the period between the separation of the bones until reaching the stage of separation, during which inflammation and the formation of callus (a kind of soft glue between the bone) occurs and it lasts up to three weeks.
- distraction phase: In which the two ends of the bone are tightened and separated from each other, and here the increase in length occurs, which is estimated at 1 mm per day and lasts for three weeks as well.
- consolidation phaseThe tension is removed and the new bone is given some time to harden and mineralize, which lasts three months.
- remodeling phaseIt is the last stage in which the formed bones become as hard as normal bones.
Techniques for lengthening surgery
There are many techniques that have been applied in the process of lengthening surgery, some of which are old and have been dispensed with, and others need more scientific evidence to prove their effectiveness.
The techniques currently used in stature lengthening surgery are classified into two main types:
- Lengthening by external fixators (external lengthening): The orthopedic consultant works on installing an external metal structure in the hospital, and this structure remains for several months.
- Internal nail lengthening (internal lengthening)This intervention is carried out by specialized doctors and requires an advanced center where screws are implanted inside the bone marrow in order to lengthen them.
Some of the currently popular operations are:
- Lengthening the stature using external Ilizarov casts for fixation: Orthopedic lengthening surgery is also called an annular external fixator, as a device is placed on the legs of patients, a device consisting of several fully rotating rings connected by several wires, This device limits movement and prevents the ends of the separated bones from spreading apart.
- Lengthening with a lengthening over nail (LON): The bone is lengthened by installing a nail at the two ends of the bone and tightening it in a way that leads to the separation of the two ends from each other. This nail may be inside the bone, which obviates the need for external fixation, especially if the patient is not comfortable using it.
Some techniques have an advantage over others. The use of external fixators in the process of lengthening the patient's height is a cheap procedure, but the treatment by it takes up to a year, in addition to the fact that the cosmetic aspect is sometimes weak.
On the other hand, modern techniques in lengthening the height are very expensive, and some people may not be able to walk after the operation for a period of time because this will lead to the failure of the process of increasing the height.
Who needs lengthening surgery?
Over the past 100 years, the need for bone lengthening has shifted from being a treatment for bone deformities resulting from many diseases such as polio, war injuries, and wrongly fused fractures, to treating other conditions that have become common, such as bone shortening and acquired joint problems, not congenital, such as injuries, infections, and interruption of blood supply to the bones and joints.
Many studies in the past focused on the therapeutic aspect of the process of lengthening the stature, but the improvement of general health and the decrease in the spread of diseases that lead to bone deformities, and the shift of the majority of work to a comfortable office system away from injuries and injuries, has prompted to think of surgery as a solution to short stature without the presence of a pathological condition that calls for it .
Nowadays, it is common for people with a condition called leg length discrepancy to undergo lengthening, often on both ends.
The candidate for the lengthening procedure must be:
- A full-grown adult in good health, preferably a non-smoker.
- He is psychologically stable and has good support from his family.
- Fully aware of the risks and damages that surgery may carry, despite its scarcity in specialized centers such asour center.
- To have an idea of the cost of the operation and the obligations involved in the instructions of the surgeon after performing it.
- There is no exact length for which the patient should undergo the process of lengthening the stature, as its procedure depends mainly on the patient's desire.
The results of the lengthening surgery
On average, it can be said that the process of lengthening the stature is successful if the length of the leg bones increases by 5 cm, or the equivalent of 2 inches, it is possible that the increase in length occurs at the expense of the bones of the thighs and legs together, then the operation succeeds by lengthening the body about 10 centimeters.
The rate of increase in height after the process of lengthening varies for many reasons such as age, gender and physical activity. Although the average rate is 1 mm per day after the operation, some patients respond differently.
In general, stature lengthening surgery has a higher success rate than its non-surgical alternatives, as the procedure has a success rate of 95% and does not leave behind a large scar, and its complications are rare.
For patients to have the best results:
- Do not hesitate to order medical advice When complications arise.
- Avoid exercise, especially strenuous ones.
- Follow a balanced diet and increase the consumption of foods containing calcium and vitamin D.
- To start with physical therapy and adhere to it after the operation, if its performance affects the results.
Lengthening surgery risks and side effects
The most important thing that patients may suffer from after the process of lengthening the stature is premature sclerosis, where the bones heal at an excessive speed that the doctor does not want, as they do not grow tall enough before the end of the operation.
In the previous case, the doctors need to do a new lengthening process with the aim of fragmenting the two bony ends again, which will raise the success rate of the intervention and lengthen the stature to the required extent.
On the other hand, some of the short stature who underwent the operation suffer from the problem of slowly increasing their height. Smoking, diabetes and the old age of the patient may play a role in this. Patients are usually followed up every 7 days during the separation phase in order to evaluate the progress taking place.
This problem is usually solved through complementary surgeries in which the doctor changes the distance of fixing the device so that it temporarily shortens the stature until the bone formation process improves, and a temporary bone graft may be used to stimulate the bones to grow if the case allows.
Among the most common complications and risks:
- Pain for a short period of time may be prolonged
- Aesthetic results are not enough
- Muscular contracture (contracture)
- Nerve and blood vessel damage
- Deformities of bones, limbs and joints
Most of the above complications can be managed and their percentage in advanced centers in Germany, Turkey, and Saudi Arabia does not exceed 15%.
Don't hesitate to Contact us To ask your questions and inquiries about lengthening surgery and its results, and to seek medical advice.
In America, the operation may cost an average of 75,000 dollars, while in Turkey, the surgery can be performed for 10-45 thousand dollars.
There is no direct pain as a result of the operation, but the patient may feel some pain in his muscles and he may feel that they are a little tight.
The implantation of an internal nail is the most appropriate procedure to increase the length because it is the safest and the best result.
Patients can return to their normal life 8-12 weeks after the process of lengthening the stature.