Phases of Limb Lengthening
1. Consultation and Evaluation
If you are interested in a consultation at the Ladisten Clinic, you need to call and schedule an appointment with one of the Clinic's orthopedic surgeons. If you are uncertain whether your medical problem can be treated at the Ladisten Clinic, you can e-mail questions and call. Mostly patients are asked to bring what previous diagnostic studies and reports, but special x-rays may be taken at the time of consultation. During the consultation, you will first be evaluated by our nurse practitioner, orthopedic surgeon of the Ladisten. After a detailed physical examination and study of the x-rays, a discussion will ensue regarding our recommended best course of treatment. If we decide that surgical treatment is appropriate, our staff, including a surgeon, will discuss all aspects of the procedure with you. After the consultation, a medical report will be prepared and can be mailed to you and any other health care personnel you choose at your written request. Please discuss the options with your referring physician, family, and friends before making a decisions. Large limb length discrepancies or multi-segment lengthenings for stature can require more than one lengthening procedure. Some patients require additional surgery before or after the lengthening to address associated problems, such as joint contractures, instability, and deformities. In such cases, the strategy for reconstruction and lengthening surgery is outlined and organized in a way in which patients and their families can plan in advance to minimize the inconvenience of these operations.
For a surgical appointment, please call +380.44.222.8054 to arrange a surgery date.
Phase 2: Preoperative Visit
Before your surgery date, you will receive instructions regarding test or docs you need to when to come for your final preoperative workup. It is required that a current medical history be obtained and physical examination be performed for each patient before surgery. Depending on your age and health status, other tests such as blood tests, electrocardiography (EKG), and radiography of the chest (chest x-ray) may be required before the surgery is agreed. Our nursing staff will help you with all of your issues. You will also have an opportunity to meet with an anesthesiologist before the surgery to discuss best methods of anesthesia preferences and their risks. Additional x-rays and/or tests may be required at this visit.
3. Limb Lengthening Surgery
For lengthening and deformity correction, the bone is usually cut through a very small incision to minimize injury to tissue. Surgery has a very low traumatic side effects, as we're trying to perform minimally invasive surgery. After the surgery, Our physical therapists initiate rehabilitation sessions the day after surgery. Occupational therapists prepare special splints to support the hand or foot during treatment. Before discharge, all patients are taught to transfer from bed to chair to toilet and to walk using crutches or a walker, if allowed. During your inpatient stay, our nursing staff will adjust your device to accomplish the necessary length.
4. Distraction
Lengthening usually begins in a few days or a week after surgery. With Ilizarov-Veklich device, this is done manually. The manual turns are performed by nurse. Because bone is a living substance, when the bone ends are gradually distracted (pulled apart), new bone grows between the bone ends. The lengthening rate is usually 1 mm per day but may be slower or faster depending on the tolerance of the bone and soft tissues to the distraction process. Most patients experience little pain during the day and this is normal. Aching or difficulty sleeping at night rarely happen but can be controlled with medications as needed. This varies from patient to patient according to individual pain barrier tolerance and the type of treatment being performed. In most cases, we allow partial or complete weight bearing as tolerated. Weight bearing actually stimulates the bone to grow, much in the same way stretching stimulates muscles and other soft tissues to grow. Most patients are allowed to shower, although we do not suggest swimming during the lengthening process. During the distraction phase, you need to be examined at our Clinic and x-rays need to be obtained every 2 to 3 weeks to evaluate bone growth, functions of nerves and muscles, and pin sites and to monitor for and avoid complications that can develop. The lengthening rate may be adjusted at these visits, and prescriptions can be refilled. Clinic's staff is available by telephone and/or e-mail to answer questions; they are available 7 days, during on or off hours, for emergencies.
5. Consolidation
After the desired lengthening or deformity correction has been achieved, all adjustments to the lengthening device cease. Newly regenerated bone is weak at that point in time and would be unable to resist shortening or breakage without the continued support of the external or internal fixation device. When lengthening is performed with external fixation alone, the external device remains in place until the end of the consolidation phase. The average total external fixation treatment time for children is 1 month per centimeter and for adults can be as long as 2 months per centimeter. The external Ilizarov-Veklich fixator is removed at the end of the distraction phase by performing minor outpatient surgery in which the internal rod is connected to the bone at its sliding end. Therefore, the external fixator is in place only for the distraction phase. The consolidation occurs with the rod alone. Bone healing is judged based on the x-rays. X-rays show us how much calcium is in the bone. When there is sufficient calcium throughout the region where the bone was separated (regeneration zone), the bone is judged to be healed. The x-rays must be obtained approximately once per month to evaluate bone healing. For international patients, it may be possible to obtain x-rays locally and to send the results via DHL or email. Your surgeon will evaluate these x-rays and advise you by phone or e-mail regarding how much longer Ilizarov-Veklich device needs to remain in place and whether there is any change in the amount of weight you are allowed to bear or the amount of physical therapy that you require. The fixator can be removed once sufficient bone healing is confirmed by radiography.
6. Removal of the External Fixator
The Ilizarov-Veklich apparatus can be removed with the patient awake (with no anesthesia).
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