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[Tibia2015]

Hi everyone,

I have been reading this and the old forum extensively for a few months. This is my first post. First of all thank you so much to all the veterans who share so much info and experiences of CLL in this forum! Which is extremely useful for future LLers like myself! I really need some advice from the veterans here, would much appreciate it if you guys give me your opinions! Thank you very much.

I am an Asian female, exactly 5 feet/152.4 cm. I want to do 6-7 cm on tibias - they are a bit shorter than my femurs. I wanted to go for Dr Quichet/Paley/Betz initially as they're the best. Finance or time is not an issue, I work for myself so I can take time off.

However I am deterred by having to spend months overseas during lengthening phase. I am from Singapore - for those who are not sure where it is, it is 4 hours flight from countries like Korea/Hong Kong.

Though I can take time off, I prefer to do in my home country. All of us would definitely prefer that. Hence the title of my post - the local doctor who does cosmetic LL only offers ISKD or Monorail Fixator/LATN. He used to do LON, and does not like that method, and of course he can do external Illizarov, which I do not want this method. 

Some background abt this doctor. He has done limb lengthening surgery for 20 years, mostly for medical cases, hundreds of cases. For cosmetic LL, he has done 5-10 cases a year past 10 years. He is a renowned LL surgeon here, and basically doing the most cosmetic LL cases. Other medical LL surgeons here do not want to do much cosmetic LL, maybe a few here and there.

I have met the doctor, he mentioned he doesn't do Fitbone as patients here find it expensive. Hence I have the impression he can bring in Fitbone if he wants to, though I don't know if he is experienced with Fitbone.


I have read the pros and cons of external and internal methods. However there isn't much info on ISKD - most info on internal methods is for Fitbone, Precise, Quichet nail etc.

I have read KiloBahn's post summary on the various methods.

Pros for Monorail Fixator/LATN (the doctor will insert the nails after lengthening phase)
- someone here mentioned even Dr Paley said that's best for tibias
- can lengthen more
- more weight bearing
- faster recovery

Pros for ISKD
- less scars (I am not too concerned abt this, I will just do cosmetic surgery to remove scars later if do LATN)
- more comfort and less pain, no ugly external fixator, though monorail fixator is less bulky and less ugly than LON/Illizaroz fixator

What do you guys think?... Do I get my facts straight?... Thanks again guys!

[KiloKAHN]

The main problem with the ISKD is that it sometimes has a "runaway nail" issue, which means that the rate of distraction can't be controlled. It can also jam and stop distraction, with the only solution being to have another surgery and getting it replaced with a new ISKD. If you are financially set to where price is not an issue, then you would probably be better off going with an Albizzia/G nail under Dr Guichet or a Precice 2 nail, which various doctors are now offering.

[Tibia2015]

The surgeon also does Lengthening And then Plating (LAP).

In another thread TRS mentioned the advantage of LAP "From the studies, LAP showed lower incidence of misalignment and deep infection compared to LON. LON has a high risk of permanent knee pain (30-50%) from the insertion of the IM nail which LAP avoids."

I am not sure if the surgeon also does Lengthening Over Plating (LOP). Which TRS mentioned the benefit of LOP is "Perhaps LOP may avoid harming the regenerate once the fixators are off."

[Tibia2015]

The main problem with the ISKD is that it sometimes has a "runaway nail" issue, which means that the rate of distraction can't be controlled. It can also jam and stop distraction, with the only solution being to have another surgery and getting it replaced with a new ISKD. If you are financially set to where price is not an issue, then you would probably be better off going with an Albizzia/G nail under Dr Guichet or a Precice 2 nail, which various doctors are now offering.

Thanks KiloKahn. Yes I am aware of that. Hmm perhaps I can ask around if there's any LL surgeon here who offers those nails... I really prefer to do in my home country. Of the patient diaries I have read, it seems that YellowSpike and ShyShy with Quichet stayed the shortest time abroad, and even that is 3 months... I do not want to spend even few weeks abroad doing LL.

But if other LL surgeons here offer those nails, they do mostly medical LL. The surgeon I talked to is the only one does the most cosmetic LL. Is the concept the same?... Hence if I find other surgeons here who offer those nails, and they're experienced in medical LL though not much cosmetic LL, I shd go with them?

How if no surgeon here offers those nails? ISKD's jamming... does it only involve having to replace a new ISKD and slight delay of distraction? If so, that might not be so bad...

If I can only choose ISKD or monorail fixator/LATN or LAP/LOP... which should I go for? Thanks so much again...!!!

[Medium Drink Of Water]

But if other LL surgeons here offer those nails, they do mostly medical LL. The surgeon I talked to is the only one does the most cosmetic LL. Is the concept the same?... Hence if I find other surgeons here who offer those nails, and they're experienced in medical LL though not much cosmetic LL, I shd go with them?

How if no surgeon here offers those nails? ISKD's jamming... does it only involve having to replace a new ISKD and slight delay of distraction? If so, that might not be so bad...

The concepts of medical LL and cosmetic LL are exactly the same.  I'd venture to say that cosmetic LL is actually easier since you're starting with healthy legs, and the only thing the doctor has to do is lengthen them without messing them up.

You're right about having another surgery and a slight delay if the ISKD jams.  That's pretty much all you'd have to worry about.  If that's an acceptable risk to you, you should probably go with ISKD.

[Tibia2015]

By the way, good luck on recovery KiloKahn! I read you're 7 months post surgery now, and starting to walk on walker/crutches, though it's still at difficult phase... Hope all will go well!!!

[KrP1]

why you dont consider Paley?

[Tibia2015]

Hi KirP1,

Originally I wanted to do with Quichet/Paley/Betz. But I realize I really do not want to spend even a few weeks overseas

It's so much better to be at home, where I have friends, and my daily activities to keep me from feeling bored during the process.

I can consider Paley if... I can leave the US 2-3 weeks post surgery? Do lengthening at home... fly back and forth to US every 1-2 months is not an issue to me. But I don't think this is possible?

Quichet definitely wants patients to stay "continuously" there until lengthening is done, which is YellowSpike's case is 4 months!

[Tibia2015]

Hi MDOW,

Thank you for your opinion. The surgeon I talked to stated ISKD I may get 5-6 cm, and monorail/LATN I may get 6-7 cm.

The downtime for LATN is supposed to be shorter by abt 1-2 months, but he mentioned in the case of ISKD, he can do bone grafting 3-4 months after surgery to aid in consolidation. He will be using aloegraft bones. This will fasten process to be about the same as LATN...

If I do not mind the extra 1 cm, perhaps I should go with ISKD... if downtime is about the same, and it is more comfortable/less painful.

What are your thoughts that you recommend ISKD over monorail/LATN? Thanks!

I am wondering about why Dr Paley said monorail fixator is the best method for tibias, this info is shared by a member here who mentioned Paley e-mailed his friend... However I know opinions are subjective. Various methods should be ok as long as by a competent surgeon.

[itzrammi]

Have you visited Dr.Sarabjit Singh in Spore? 


http://www.asami-asean.org/founder/DrSarbjitSingh.asp

[KrP1]

what about Dr Donghoon Lee ? he is in asia

[Tibia2015]

Considered that too. Classical has a diary here she did with Dr Dong Lee and she stayed in Korea for 5 months.

Basically if I have to stay abroad "continuously" for more than 2-3 weeks... I rather not.

[Tibia2015]

Have you visited Dr.Sarabjit Singh in Spore? 


http://www.asami-asean.org/founder/DrSarbjitSingh.asp

Hi itzrammi,

That's the surgeon whom I met. Are you from Singapore too?

[KiloKAHN]

Thanks KiloKahn. Yes I am aware of that. Hmm perhaps I can ask around if there's any LL surgeon here who offers those nails... I really prefer to do in my home country. Of the patient diaries I have read, it seems that YellowSpike and ShyShy with Quichet stayed the shortest time abroad, and even that is 3 months... I do not want to spend even few weeks abroad doing LL.

But if other LL surgeons here offer those nails, they do mostly medical LL. The surgeon I talked to is the only one does the most cosmetic LL. Is the concept the same?... Hence if I find other surgeons here who offer those nails, and they're experienced in medical LL though not much cosmetic LL, I shd go with them?

How if no surgeon here offers those nails? ISKD's jamming... does it only involve having to replace a new ISKD and slight delay of distraction? If so, that might not be so bad...

If I can only choose ISKD or monorail fixator/LATN or LAP/LOP... which should I go for? Thanks so much again...!!!

Lengthening is the same concept whether doing it for cosmetic or reconstructive reasons, though it was the opinion of my surgeon that if you are getting cosmetic lengthening, then you want to go to surgeons trained in Ilizarov that are at the top of the pyramid - the best of the best, in other words - because when you are operating on a healthy individual there is much less room for error than operating on someone with a deformity, otherwise you risk making a healthy person crippled. If you go to a doctor with a lot of experience treating deformities or injuries with Ilizarov, he'll likely be very experienced in knowing how to prevent or treat the various complications that can happen with limb lengthening.

If you're okay with getting extra surgery if the ISKD malfunctions, then ISKD is an acceptable method. You'd just end up paying more than you initially thought because of extra trips to the operating room.

Hi KirP1,

Originally I wanted to do with Quichet/Paley/Betz. But I realize I really do not want to spend even a few weeks overseas

It's so much better to be at home, where I have friends, and my daily activities to keep me from feeling bored during the process.

I can consider Paley if... I can leave the US 2-3 weeks post surgery? Do lengthening at home... fly back and forth to US every 1-2 months is not an issue to me. But I don't think this is possible?

Quichet definitely wants patients to stay "continuously" there until lengthening is done, which is YellowSpike's case is 4 months!

You're right that being able to stay in your home country to lengthen is a good idea. Being surrounded by friends and family will be much better for you mentally than being stuck alone in a hotel room or something similar. If you can find a good doctor in Singapore, then you would have that advantage of doing it there. However, if you choose to go abroad you really don't want to fly back home during the lengthening phase. Complications can happen at any time and you want to be in close proximity to your doctor so it can be caught and treated early. Most docs will want you to stay nearby for the lengthening phase at least. Once lengthening is over and you start consolidation, then going back home is fine and you can send your doctor x-ray updates by e-mail every month or so.


As for ISKD vs LATN, I'd personally go with LATN if lengthening tibias and only ISKD if doing femurs. LATN shouldn't cost as much and lengthening with the Ilizarov frame is more reliable than lengthening with the ISKD. The annoying thing about wearing external devices however is that it can make sleeping more uncomfortable, and cleaning the discharge from the pin sites can be annoying. The sites can also get infected and painful, requiring you to take antibiotics. ISKD would certainly be more comfortable and will give you less scars. Heck, if money is no issue at all you might want to stick with ISKD to not deal with the hassle of external devices.
 

[itzrammi]

Hi itzrammi,

That's the surgeon whom I met. Are you from Singapore too?

No am from India but I am about to consult him in May but now am shocked you said he isn't offering FITBONE

[Tibia2015]

Lengthening is the same concept whether doing it for cosmetic or reconstructive reasons, though it was the opinion of my surgeon that if you are getting cosmetic lengthening, then you want to go to surgeons trained in Ilizarov that are at the top of the pyramid - the best of the best, in other words - because when you are operating on a healthy individual there is much less room for error than operating on someone with a deformity, otherwise you risk making a healthy person crippled. If you go to a doctor with a lot of experience treating deformities or injuries with Ilizarov, he'll likely be very experienced in knowing how to prevent or treat the various complications that can happen with limb lengthening.
 

Hi Kilokhan,

Awesome pointer! I didn't think of that. That describes my potential surgeon here. Now I feel more ease of mind doing in my home country.

Terribly sorry I am replying so late. I had read your post since it was posted. But suddenly encountered some crises at work, and my whole attention was on it. Hardly logged on here.

Thank you very much again for your replies to my post. I am mentally preparing to perhaps do LL towards end of year.