Length Extension Surgery in 10 Steps

1 – Why Do People Want to Grow Taller?

Today, the active use of social media, the changes in world trends, the advancement of visual materials and technology have significantly increased the mutual interaction between people; This has increased people's desire to be liked more, their desire to be accepted and their expectations of position in society. The desire for people to be accepted as an individual increases their visual expectations over time. Although the perception of aesthetics and beauty has changed over the centuries, the desire for self-love and acceptance by the society continues. These expectations are gender-neutral.

2 – To Whom Is The Lengthening Surgery Performed?

It would be more accurate to examine lengthening surgeries in three main groups:

In the first group, there are patients due to shortness of one leg, arm or finger. These patients may have congenital shortness as well as due to accidents, bone infections, tumors, unilateral delay in elongation, relative shortness due to bone curvature (DEFORMITY).

The second group includes congenital dwarfism. The most common cause is Achondrodystroplasia, and it can also occur in growth hormone deficiencies. Male height 135 cm, female height 130 cm usually cannot exceed the limits. In these patients, the first intervention should be done at 5-6 years of age. Second session operations are performed at the age of 10-12 on average. In some patients, a third session of surgery may be required. An average of 20-25 cm extension is possible. It is also possible to perform curvature correction (deformity) and lengthening surgeries in the same session in adult patients.

In the third group, there are patients with height increase for cosmetic purposes.

According to the data of the Turkish Statistical Institute (TUIK), the average height in our country as of 2010 is 172.6 cm for men and 161.4 cm for women. Cosmetic lengthening surgeries can be performed in patients who are below these values, whose growth lines are closed, and who do not expect further growth by natural means.

3 – How to Prepare for Lengthening Surgery?

In patients presenting due to shortness, first of all, general health status, bone quality examinations should be performed depending on age, clarity of growth lines. The causes of shortness should be investigated in children and in patients with open growth lines; familial shortness and hormone deficiencies, congenital diseases etc. distinction should be made and if necessary, their treatment should be carried out in accordance with the relevant branches. Individuals with closed growth lines should definitely seek the help of a specialist psychologist for cosmetic extensions.

4 – How Are Lengthening Surgery Performed?

Lengthening or shortening surgeries can be performed much more frequently and less smoothly in parallel with the technological and medical developments that have recently developed. The bones to be lengthened are cut in a controlled manner and the lengthening is achieved by opening 1 mm between the bones daily.

In lengthening surgery, 3 main techniques are applied in our country, as in all developed countries.

• Extrinsic Fixator Assisted Extension;

It can be done with 2 basic extension devices.

A – The first of these is the ILIZAROV EXTERNAL FIXATOR (Ring extension device). It is the method described by the Russian physician Gavril Abramovich Ilizarov in the 1950s. It is popularly known as the ring method.

FIGURE 1. Extension by the Ilizarov method

Although curvature correction can be made with the Ilizarov method, it is not widely used in cosmetic lengthening due to skin problems, risk of infection, roughness of the instrument and patient incompatibility. It can carry full load.

B – The second external fixation and extension method is MONOLATERAL EXTERNAL FIXATOR (one-sided extension device). The extension with this method has the same principles as the Ilizarov method. However, the more gentle form of the device increases patient compliance much more. Skin problems and the risk of infection are much less. Today, due to these advantages, it has become a common method for external lengthening surgeries. It can carry full load.

FIGURE2. Lengthening with the monolateral (one-sided) extension device method

• Extension with Closed System (Precice, Fitbone)

This method is known as the closed method. It is made using a nail placed in the marrow cavity of the bone. Since the marrow only works actively in the spine and pelvis, except in childhood, this method does not harm blood production. Two generations of nails are available. In the 1st generation, the motorized system is used, in the second generation, the magnetic extendable rod system is used. Custom production is made. With the help of special tools, elongation is provided by stimulating the nail from the outside. In this method, since it can be applied closed, skin problems are very few and aesthetic results are close to perfect. The risk of infection is negligible. The biggest disadvantages of this method are their inability to carry full load due to sensitive elongation mechanisms and their high cost.

FIGURE3. Extension with the closed system extension device method

• Extension with Combined System

In this method, both the closed nail and the fixator system that provides extension from the outside are applied together. The aim of this system is to enable the patient to get rid of the external apparatus much earlier and to extend it more anatomically without shifting in the bone over a more stable system. This method also provides a significant advantage because it provides more cost-effectiveness compared to the completely closed method. It can carry full load.

FIGURE4. Extension with combined system

5 – How Long Is It Possible to Grow With Lengthening Surgery?

Theoretically, it is possible to extend up to 80% of the bone to be lengthened, but in practice, this lengthening cannot be done due to the restriction of both muscles and nerve and vascular network. In pediatric patients, it is possible to lengthen up to 20-25 cm after early diagnosis, starting at 5-6 years of age and after 2-3 sessions of surgery. For adult patients who want 2 sessions, lengthening can be provided up to approximately 10-16 cm.

6 – How Long is the Extension Period?

Whichever method is used, the extension process starts following the 7-10 days of recovery (rest) period. 1 mm lengthening is applied daily. For roughly 5 cm lengthening, this period is 10 days of convalescence + 50 days of extension = 60 days. The maturation period in the elongated bone is about 1 year.

7 – How Long Can Extension Devices Be Removed?

The main difference in extension methods is the removal time of the externally visible extension device. In all-out methods (extension with external fixator), this time is approximately 4-5 times the lengthening amount. In the combined method, this period is between 4-5 months due to the load bearing of the nail inside. In completely closed methods, there is no external device.

TABLE: Average treatment times for 5 cm lengthening.

*Due to the inability of the device to carry a load in the closed method, the time is doubled in cosmetic extensions as the sides are made one by one. Since the system is under the skin, removal is not possible. The specified time is the time required for the second party to be made, and the extension is completed in 120 days in total.

8 – Can lengthening surgeries be performed outside the legs?

In selected and suitable patients, lengthening surgeries and differential treatments for the shortness of the arms, fingers and toes other than the legs can be carried out successfully.

9 – How long is the hospital stay?

The hospital stay is about 5 days. During this period, patients are taught basic wound care, use of lengthening devices, walking and joint movements, strengthening movements, sitting and standing exercises, methods of combating pain, and personal hygiene methods. Psychological support is provided. In this way, it is aimed to provide patients with basic knowledge that they can sustain their lives on their own. It is recommended that patients coming from outside the city do not go out of the city for 10 days. In the next period, follow-up with weekly control radiographs (x-ray) is sufficient. Professional physical therapy should be started in the 4th week after the extension is started. Since it is not possible to load the extension with the closed method, it must be done unilaterally. When the extension is completed, it will be possible to walk with full load. In other methods, it is possible to walk with full weight bearing the day after the surgery. Since it takes about 1 year for the newly formed bone to fully fuse, sports that require struggle should be started after this period. Swimming, cycling, walking and jogging can be done in 3-4 months.

10 – Are There Any Risks of Lengthening Surgery?

Basically, we can examine the risks of these surgeries in 2 main groups. The first is the risks related to the chosen anesthesia method. These surgeries can be performed with spinal-epidural anesthesia or general anesthesia depending on the patient's preference and general health status. Post-surgical risks include pain, bleeding, infection, joint stiffness, vascular coagulation (thromboembolism) and delayed union. These risks have decreased significantly in parallel with today's technological and medical developments. The use of painkillers, appropriate antibiotic applications, the conscious consumption of blood thinners whose risk is greatly reduced, early movement and walking exercises, balanced nutrition and personal hygiene have decreased to almost non-existent levels.