Aesthetic orthopaedics

Surgical operations for correcting the appearance, for changing the shape of nose, lips, ears, breast volume, and liposuction came into our lives a long time ago. However, the problem of the leg deformity can remain unsolved, causing women suffering throughout their lives. Short skirts, tight jeans, shorts and other similar clothing unfortunately become an inaccessible dream. Women (and sometimes men) suffer because of insensitive remarks and mockery. Besides the aesthetic affect, the problem also has a medical aspect. People with a strong tibial bowing (due to the incorrect load distribution on the joint), by the age of about fifty years start developing serious arthropathies which may lead to disability.

Historical background

The origins of plastic surgery date back to ancient Egypt, where the doctors had been practicing operations for the correction of “harelip” and amputated (for whatever reason) noses. In ancient times similar methods were used by the healers of Persia and Arabia. 600 years B.C. in India there were frequent inter-tribal wars, and the prisoners had their noses cut in order to be easily distinguished within the crowd of people. Thus the reconstruction of the nose was a serious and urgent problem for the people of such eastern countries. Time has preserved even the exact name of an Indian doctor who described the operation, Sushat Samgit.

Method Ilizarov

The method of limb deformity correction and lengthening was offered by a great Russian scientist born in Caucasus, named Gavril Ilizarov. For the first time in global medical practice, Ilizarov practiced the method of developing the tissues of the organism. That is, he observed and proved that after osteotomy and the gradual removal of bone, new bone regenerates. At the same time, vessels, nerves and soft molecules are regenerated (a method of extensive histogenesis). In 1951 he designed the outer bone osteosynthesis consisting of needles, rings and rods (Ilizarov’s external osteosynthesis). Today this method is widely used not only in Russia, but also in many European Centers of Orthopaedics. Due to the significance and prevalence of the pathology, during the recent years, many orthopaedists have identified this method as a separate field called “Plastic orthopaedic surgery”.

Reasons for height gain

At this point I would like to highlight the reasons that lead people to a painful process of height gain. The average height of a European man is 176 cm, and that of a woman 169 cm. The ultimate height of any human being depends on the inheritance we received from our parents. Increasing height with exercises will not work well. I do not recommend using medicines (growth hormone) to increase height in childhood!!! It has many side effects, up to the appearance of cancer. For people up to 145-155 cm tall (145 cm – women, 155 cm – men) the increase is performed for medical reasons, due to low stature. This group includes patients with achondroplasia (dwarfs). On the contrary, for people over 150 cm tall, the increase is now made for aesthetic reasons. Usually it is females who want to do modeling or men who want to take exams in military schools and do not qualify for the height standards. A second reason for height gain is people’s psychological distress with their height. Of course, in these cases the increase is made not only for aesthetics, but mainly for therapeutic reasons to deal with their psychological problems. The initial height of some people in this group may be quite high, reaching as high as 180-185 cm. However, I hasten to emphasize that patients with psychiatric problems have a contraindication for height gain.

Wrong perception

Some consider the height-raising process to be completely painless and harmless. This perception is wrong. Initially, until we reach the desired length, the process is sometimes laborious and difficult to navigate. Smoking is one of the factors that influence osteogenesis. That is why smokers who want to increase their height should definitely quit smoking. Some orthopedic centers abroad, motivated by commercial interests and ignoring the dangers, propose an increase of over 7-8 cm. The ideal length of harmless elongation is 5-6 cm, which ensures the correct ratio of femur and tibia length.

Technique

Modern leg deformity correction operations are performed under general or regional anesthesia. At the first stage, above or below the intended incision on the tibia, special pins are placed, which are fixed on rings, which, in turn, are arranged into the Ilizarov apparatus. At the second stage the doctor cuts the leg bone at the top of its bending and simultaneously or gradually performs the correction. When elongation is required, the deformity angle correction and the lengthening are made simultaneously. On the second post-operative day, patients usually begin to walk with crutches. A month later, there is no need for crutches and patients can walk with full weight-bearing. In case of leg lengthening the patient must tighten some nuts of the unit 4 times a day. The bone growth rate one millimeter per day in average. The period of regeneration and maturation of the newly formed bones range from three to five months. After removing the apparatus the patients are advised to avoid strenuous exercise and heavy physical activity.

«EXPRESS» elongation method

I would like to say my opinion on the “EXPRESS” method of elongation for 4-5 cm within two months, which is also advertised by various orthopedic centers abroad. The “EXPRESS” elongation method is a combination of intramedullary nailing and the circular system of external osteosynthesis (double cost) or simple intramedullary nailing. In this case, by saying two months after the elongation, they do not calculate the time of maturation of the newborn bone that is twice the time of regeneration. In addition to the first surgery, two more operations (removal of external osteosynthesis, removal of the intramedullary nerve) will be needed to complete the treatment. It also hides many risks that can lead to a patient’s disability.

A patient, 22 years of age