Surgical Procedures:the whole surgery is performed with
minimal invasion, with minimal trauma involved. There is hardly any bleeding
and the leg lengthening surgery usually lasts about 60 minutes, the total
time needed including pre-operation preparation (anaesthesia and recovery)
and the surgery is about 2 hours.
Anaesthesia: epidural anaesthesia is routinely used, and sedatives
are given before the surgery. These is no pain during the surgery and
no notable side effects after surgery.
(b) The surgical cuts: There will be a 1-cm cut at the
medial and lateral aspects of the tibia, just below the knee joints.
(c) Osteotomy at tibia and fibula: The osteotomies (cutting
the bone) are performed using a specially designed osteotome and devices,
with minimal invasion and trauma involved.
(d) The application of external lengthener and intramedullary
nails: first the inter-locking intramedullary nails are carefully
inserted into the tiabial bone marrow cavity through the 1cm skin cut;
then the dynamic external lengthener is applied. Total 6 thin wires (2-2.5
mm in diameter, 2 at proximal tibia level; 2 at the tibia near the ankle
joints and 2 through the callaneus ) are used to connect the external
lengthener to the tibia.
(a) Early stage:antibiotics are given intravenously for
3 days following surgery; the operated legs are raised slightly and patients
should stay in bed for about 7 days. 5 days after surgery, patients are
encouraged to exercise the operated legs in bed.
(b) Lengthening period: the lengthening begins at 8 day
post surgery, rate: 0.5-1 mm/day; rhyme: 4-6 steps/day. The patients will
undergo weight-bearing functional exercises (Figs. 3 and 4) during lengthening.
||Fig 3. Walking with a walking aid during lengthening
||Fig 4. Exercise on a function device
Removal of external lengthener: when the planned lengthening
is achieved the intrmedullary nails are locked to maintain the length,
and the external lengthener is then removed, under general anaesthesia.
Patients can weight bear fully after the surgery and may discharge from
the hospital. However, they need to come back for follow-up checks every
3-4 months till the removal of the nails.
(d) Removal of intramedullary nails: the nails will be
removed (taken out) approximately 6-16 months following the removal of
the external lengthener, depending the total lengthening and the mineralization
of the new bone. The treatment is completed once the nails are removed.