Biologically, limb or height lengthening is realized when bone formation happens at the growth plates on our bones, which are located at the tips of our arms and legs, a natural physiological elongation process. This natural process, generally, ceases growth upon attaining the age of puberty around 18 years; as the growth plates tend to close; hence the only possible choice after puberty, is limb lengthening surgery. Such surgeries can be performed for both arms and legs correction and elongation.
Moreover, the actual height lengthening process comprises of surgically elongation of both leg bones, simultaneously, in the same surgical operation.
History of Limb & Height Lengthening:
A Russian orthopedic surgeon, Gavriil Ilizarov, was the first medical orthopedic specialist to be credited with inventing a limb lengthening device “the external fixator”, in 1954. This device manually pulled bones apart in order to increase the patient’s height and it proved as a God sent for patients suffering from polio, congenital limb defects and dwarfism.
Having said that, adding centimeters isn’t stress-free task with this methodology. Ilizarov’s (1954) “fixator” mechanism, which is still in use today; patients undergo a general anesthesia and the surgeon makes a small incision in the leg, either the tibia or femur bone, whichever bone is opted to be lengthened is separated, thus fragmenting the bone into two. Furthermore, the surgeon drills screws into the top and bottom of the bones and 1.5-2 mm steel wires are attached into the bone separations, inserted from one side of the bone and extracted from the other side. At least, 8 wires are attached in this way; which are made of aluminum, steel or carbon; and fastened with 4 rings at minimum. The wires and screws are fastened into a metal frame that stabilizes the leg during and after the procedure. The body’s natural healing process, does the rest, by filling the gaps within bone tissue, thus lengthening the limb, in the process, naturally.
However, having said that, this system, does have its setbacks, as vascular nerve injury and infection are the most common and key complications. It is also the most troublesome methodology in terms of patient compliance and comfort.
Having said that, an improved version of this methodology is practiced by Wagner and De Bastiani, which consists of monolateral pin type fixator, whereby fixator-induced complications are less likely and patient compliance and comfort is superior to the original Ilizarov’s methodology. This new and improved method of applying a nail extending into the bone is the most preferable and comfortable method in terms of patient success and accommodation. But this system is not applied and recommended in all patient cases. As this method, is relatively new, the data and feedback available, is generally limited. It is strictly advised that those patients who opt for this method, must use a wheelchair, and not to allow the patient to press or exert weight on the limbs, during the extension period.
Furthermore, in case of the patients contracting an infection, the procedure is halted, until the time that the infection is treated and subsides, which may halt the lengthening process. It must also be noted that this method is also one of the most expensive options available, currently.
Leg Lengthening with “HOLYFIX” Methodology:
The “HolyFix” method is a Monolateral pin type method which has been in application with success results, since 1997. It is an improved version of Wagner and De Bastiani methodology.
In other words, its formation happens by attaching to the bones one side, to the nails which, in turn are attached, from the exterior, to the “HolyFix” device. The nails are attached to the nearest and safest area, especially not near any vein and nerve, while the nail remains in the bone, thereby they do not cross. The chances of open wound infection are much rare and does not prevent or hinder completion of the lengthening process. This risk is significantly reduced to a minimum owing to the “Holy-Pin”, which is part of the “HolyFix” method, parcel.
The “HolyFix” apparatus is made-up of a specialty aluminum and titanium alloy, thus lighter in weight and is “MRI” and radiology compatible. Hence, making this biomechanical system extremely stable and safe; allowing the patient to walk during the treatment phase. This device makes the “Extension” process very practical and easy, allowing the patient to perform extensions on their own. In addition, “HolyFix” apparatus has such a superior design that it allows for accelerated bone formation and transfers the burden from the bone without any shortening (Dynamization).
The Extension process consists of six phases:
- Inspection and Medical Examinations
- Lengthening Period
- Bone Strengthening (Consolidation)
- Removal of the System
1. Inspection and Medical Examinations: Once the patient is admitted to our clinic. Radiological examinations, measurements and other necessary examinations are carried out. The patients are informed about everything, related to the lengthening process in detail. These inspections and examinations are planned and carried out on the day of surgery and soon the after surgery itself.
2. Surgery: The patient will be called to the hospital at least one day before the operation in order to have pre-operative screening, meeting the Medical teams and the hospital and treatment team. The operation is performed under either a general anesthesia or a spinal anesthesia. The anesthesiologist and the patient have to decide this aspect together.
Our surgeries are performed with the help of tourniquet, hence bloodless; thereby the chances of bleeding are very rare. Thus, there is, generally, no need for any blood transfusions.
ARM OR LEG EXTENSIONS:
If the length of bone which is to be extended or lengthened is up to 5 cm at one level, it is extended over 5 cm, two level cuts are surgically made. Two or three nails are applied to both sides of the area which is to be cut before the bone is separated; this is mainly dependent on the body weight (BMI) of the patient. Henceforth, a suitable “HolyFix” fixator is prepared and applied.
During the surgery, an incision is made on the skin section at about 3 to 4 cm at each level and the device is aesthetically internally planted and hence there are no stitches which need to be removed. Single-zone single arm-leg lengthening surgery takes an average 40 minutes; on the other hand a double-zone single arm-leg lengthening takes about 60 minutes.
Height lengthening is a process of both legs extension. Whereby, both the legs are lengthened at the same time, thus the patients height is increased, simultaneously. Length lengthening surgeries, generally, take about 90 minutes for single level (up to 5 cm), 2-2.5 hours for a double level (up to 10 cm).
3.HOSPITALIZATION: The hospitalization is in a single room to accommodate one person.
If the patient’s singular arm or leg is to be lengthened, they would have to reside at the hospital for 2 to 3 days; in case, of stature or both leg lengthening is to be achieved, their stays would last between 4 to 7 days. During this period, the patients are informed about the treatment and the lengthening process, in total. Walking with crutches and nail care and maintenance is thoroughly taught. Physiotherapy training is given to the patient and exercises are taught and the lengthening process is taught, practically.
4. Lengthening Period: Normally, this process of lengthening starts at the hospital. The lengthening is taught to the patient and who may extend the limb lengthening by a total of 1 mm per day in four equal parts (4 × 0.25 mm) at each lengthening level.
The patient is discharged after this time and may return to their homes. However, patients who would like to reside in our care more often can stay in our hospital or at accommodation centers close to our clinic. During this time, the patient can function movement with the help of crutches. Throughout this journey of the patient, our physiotherapy team are with them; helping with exercises and teaches them stretching, muscle and joint movements during this lengthening period. The patient should perform these exercises during the entire course of the treatment. The patients are also taught nail care and maintenance. From the second week of the surgery; (except in special and rare cases), the patient can bath during the treatment. Clinical and radiological examinations are performed after every 15 to 30 days, periods.
5. Bone Strengthening (Consolidation): After the lengthening process is completed, the elongated bone area is strengthened and consolidated at becoming load bearing.
Full Recovery of the bone after Lengthening:
The recovery period is approximately one month for each approximate centimeter gained, within the lengthening period. Whereby, regular medical examinations, are necessary, after every 20 to 30 days period. Patients living outside the city or country could easily perform regular checks by sending their X-rays and, if necessary, photographs.
6. Removal System: After the lengthening and consolidation periods are completed, the system is removed; easily and painlessly under local anesthesia or general anesthesia at our hospital. Our medical professionals, make sure that no other materials are left in the patient’s body. Long walks, heavy exercises and sports are, generally prohibited, until the time that the bones have fully recovered to normality, subsequent to the removal of the devices. However, ample swimming is a recommended exercises. Generally, most physical activities are allowed, as long as the bones are of the same quality and integrity to the other bones, of the patient.
Packages and Total Costs (2019):
The average cost for such a Limb Lengthening surgical procedure, where the “Holy-Fix” methodology is opted: (€) 15,000 Euros. (May 2019)
Furthermore, for a complete healthy and smooth limb lengthening experience, we provide the following facilities, which are included in the total price:
- Meeting and greeting our patients at the airports, including all transportation to the hotels & hospitals
- Accommodation in a 5-star hotel (1 to 3 days)
- An English-speaking caretaker who will assist our patients 24/7
- Complimentary Istanbul tour, including historical and touristic visits, boat tours and meals in our famous Turkish restaurants
- All necessary medical examinations and tests before the surgical operation
- 5 to 7 days of hospitalization
- Physiotherapist’s assistance and all medications are covered, during the patient’s hospitalization
- Walker, crutches & wheelchair for support & assisted movement (Post-Op)
- Transportation to the airport upon departure
- FREE consultation with doctors and consultants whenever the patient’s needs, even after lengthening process has been completed.
The above mentioned price also includes the following costs, in addition, to the surgery itself.
- All hospital charges relating to the operating room and recovery room.
- Surgeon’s fees.
- Anesthesiologist’s fees.
- Surgical assistant’s fees.
- Hospitalization fees (Internal medicine doctors will be available during the entire hospitalization period).
Furthermore, you can contact our patient consultants, at your convenience, for a detailed discussion regarding the procedures and any information that you may require in relation to the procedures, medical teams, prices and any available discounts.
Patients are expected to return to their normal walks after a height increasing surgery, as seen in the following video.