Limb Lengthening Surgery- The Process?
Limb lengthening surgery as the name suggests is the lengthening of the limb. Limb lengthening is
achieved using the body's own capacity to regenerate new bone. The process begins with an
operation called an osteotomy in which the surgeon cuts the bone to be lengthened and its fixed
by different internal or external devices.
Then the bone is distracted with the help of the external or internal device, the gap is created between the two ends of the bone. The gap is filled by the new bone formed. This process is called distraction osteogenesis.
Earlier the method distraction osteogenesis was used for the complex fractures, Limb length deformity, trauma or non union bone transfer.
How the limb is lengthen
The bone to be lengthened is cut in the proximal ⅓ called osteotomy
Metal Pins or screw are placed through the skin and into the bone. pin are placed above and below the cut into the bone stitches are used to close the wound
A metal device is attached to the pin in the bone; it will be used later to very slowly pull over the cut bone apart the widen the space between the end of the cut bone that will fill in with new bone.
If the limb lengthening surgery is done over the nail the frame can be removed once the desired lengthening
is done and let the bone heal by itself with callus formation this method is called lengthening
over nail but if the lengthening is done on purely over external fixator the external fixator is
supposed to be Carry until the new bone is formed and this is called pure ilizaro method.
In both the cases either it's lengthening over nail or pure ilizarov the lengthening is done very
slowly about per 1MM per day.
While we are distracting the bone we have to regenerate the soft tissues,ligaments,blood vessels and nerves that surrounds the structure and support it.
As earlier may mention 2 phases of recovery follow in the 1st destruction phase the bone that has been cut is very gradually pulled apart in process that promote distraction osteogenesis or new bone growth. As the space between the end of the bone open up the body continue to produce new tissue in the gap until the desired length of the bone has been generated additional strategies are available to correct the deformity that may be present such as misalignment of the bone such as miss alignment of the bone resulting from trauma or birth defect early in this face patient walk with the aid of crutches. In 2nd phase of the treatment the bone consolidates and heal the patient gradually put more weight on the affected limb start working without any assistance.
Osteotomy and placement of the external fixation device done under the epidural anesthesia the same type of anesthesia that may many women receive during childbirth so that they may be awake during the surgery if they so choose the average hospital stay is due to 5 days the procedure involves no it's the procedure in walls no large incision or bone graft.
To check the amount of lengthening repeated series of x-rays been done to ensure the equal lengthening of both the limbs.
Recovery time for the limb lengthening
The procedure varies among patients with the consolidation phase. Theoretically one cm takes around 1 month to consolidate but it differs from person to person nutrition level. If the vitamin D3 and calcium levels are equally normal the consolidation happens in ideal timing but if the nutrition levels are low the consolidation May be slower. The amount of weight bearing has to be decided according to the frame used . If the lengthening is done over pure ilizarov method the weight bearing is more and if the lengthening is done over nail full weight bearing is not allowed till the time of full consolidation.
Limb Lengthening Surgery can be done safely and effectively in both children and dirt including those in their twenties, thirties and forties. In pediatric patients the orthopedic surgeon takes special care to avoid injury to the growth plate and both normal growth and distraction osteogenesis continues during recovery.