Below is the response from Dr. Guichet regarding his techniques....
I asked him two questions: 1) Minimum stay in Italy 2) Surgical Techniques
Dear xxxx,
Minimum stay is, for no risk, the duration of the lengthening procedure. If you are minimally concerned about risks, you need to stay till you master the clics and your training, i.e. in general 5 weeks. Do not believe a surgeon who will tell you you can leave whenever you want or after 2 weeks. You will get no security and a high rate of complication, because it is like boiling oil on gaz, if you stay close to the frying pan, you are at extremely low risks of real problems and destroying your house. An advise: stay close to the surgeon the duration of lengthening.
Now coming to surgery, you need to learn some basic surgical techniques and their implications.
Biology of fracture healing: what is the best?
Opening a surgical site (called an osteotomy) creates leaks, and the ‘healing hematoma’, constituted of all natural elements allowing healing, is suppressed. The ideal thing is to preserve completely the ‘healing hematoma' to fasten bone healing. Some bones, when we open the soft tissues are prone to non-healing. This is one of the root for the interest in surgery for stab incisions or non-open reduction of fractures, as it prevents long healing times.
Opening a surgical site to the bone is aggressive and looses the bone healing progenitors. That is why I developed a specific intramedullary saw to preserve the healing hematoma. And that is in part why my patients heal so fast. Opening creates additional scars that patients do not like when they do cosmetic lengthening.
Completing a fracture with hand maneuver (Karate Chop or whatever you call such a maneuver, as there are several technique for it) is obviously the best. It is called ‘osteoclasis’. It is generally performed on small bones, in children because it is easier to control through the skin without opening. By the way, all fracture reductions are performed manually, with hand maneuvers, sometimes in worst visual ways!
So, if you wish to preserve the fracture hematoma, you’d better not open the fracture site. Let’s go back to lengthening.
Why completing the bone section in nail lengthening?
The bone is never rounded and the posterior part of the femur os thicker. With a rounded intramedullary saw, in certain conditions and certain profiles of patients, it is not possible to cut the full posterior thickness of the bone. You have two options:
- Use an additional reaming and a wider intramedullary saw: this will decrease the thickness of the wall thus will weaken the strength of the bone, and as the bone is not rounded, you will use a saw larger than the thick part of the wall, which will rupture and dig into the normal soft tissues on the thin part of the bone, creating a frank section of the anterior periosteum. The periosteum is the element in a lengthening with a nail which is the only component from which bone is formed. So you need to preserve it, but if you cut it, your healing again will decrease strongly.
- Complete the reaming up to the section of approx. 4/5 of the circumference of the bone and complete the section with other ways.
The other ways can be:
- Osteotomy
- Osteoclasis
If you want to heal fast, you’d better not perform an osteotomy, and prefer an osteoclasis. However, in such a big bone as the femur, turning the bone like reducing a fracture does not work. If you succeed, you create generally long spiroid or long third fragments at risks, not of slow healing, but of destabilizing the bone, and additional pain. That is why I created this specific high impact non traumatizing non opened technique. It optimizes the healing process.
Doing it in large bones requires a high-level know-how. However the past president of the Japanese Orthopaedic Association congratulated me for this technique along with some other very well-known surgeons around the world.
People who post on Internet are people who do not understand how the body works on the medical side and what a surgical technique is. They should refrain from showing defaming thoughts when they know nothing and when what they show is the best option to optimize healing.
For further information:
http://www.webdictionary.co.uk:
Definitions of osteoclasis
1. [n] - treatment of a skeletal deformity by intentionally fracturing a bone
Definitions of osteotomy
1. [n] - surgical sectioning of bone
The World Bank of Medical Articles (National Library of Medicine, National Institute of Health):
http://www.ncbi.nlm.nih.gov/pubmedObviously it is accessible to the public but it is for professionals, so the search is a bit difficult for non doctor people.
You can search key words
- Fracture hematoma (see a joint print screen of an article)
- Osteoclasis
- Osteotomy
But you need to cross keywords; if not, you will not find relevant articles
However the researches I did for over 3 decades are the basis of the technique I developed and nowadays nobody question it and a lot of surgeons copy it. When I developed the internal lengthening nail in 1986, all the people at that time were saying: ‘you cannot create healing when you turn a bone, or when you destroy the bone marrow (opposite to Ilizarov thoughts)!. I was and I am still far more advanced than a lot of people and surgical teams for serving my patients.
All this is because I carefully listen to my patients (no scar, sports during lengthening, fast healing, etc.) and I could develop surgical techniques accordingly. You can review also the publications I did along with my 3 thesis (2 PhD in biomechanics and bone healing).
I hope this will rectify errors in understanding. You can post on the web my answer to you.
Of course, for any patient interested in this subject, like in other subjects, I am keen to discuss this issue during the initial evaluation consultation.
Yours sincerely,
Jean-Marc Guichet, MD, PhD, Doct. Sci.
SELARL du Docteur Jean-Marc Guichet
Centre Phocea, 14 Bd Ganay
13009 Marseille - France
Office: +33.491.777.547
Office (mobile): +33.664.163.890
E-Mail: jeanmarcguichet@gmail.com
Web:
www.allongement-os-grandir.comStudio SOMA
Via Nicola Piccinni, 3
20130 Milano (MI)
Italy
Office: +39.328.634.2941
E-Mail: jeanmarcguichet@gmail.com
Web:
www.allongement-os-grandir.com
Author
Topic: Dr. Guichet Dangerous Surgical Technique? Video and Interview (Read 17570 times)